Provider Demographics
NPI:1710406525
Name:GEBHARD, WILLIAM (OD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:GEBHARD
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:14866 OLD ST AUGUSTINE RD
Mailing Address - Street 2:UNIT 110
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32258-2611
Mailing Address - Country:US
Mailing Address - Phone:904-379-5450
Mailing Address - Fax:904-372-8223
Practice Address - Street 1:14866 OLD ST AUGUSTINE RD
Practice Address - Street 2:UNIT 110
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32258-2611
Practice Address - Country:US
Practice Address - Phone:904-379-5450
Practice Address - Fax:904-372-8223
Is Sole Proprietor?:No
Enumeration Date:2017-09-12
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC5377152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist