Individual
WILLIAM ROY SHOULDICE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
350 W NORTH ST, GAYLORD, MI 49735-1525
(989) 732-6455
(989) 732-1102
Mailing address
PO BOX 1665, GAYLORD, MI 49734-5665
(989) 732-6455
(989) 732-1102
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4901003939
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0585020001
ADMINASTAR
MI
01
—
0M69410
MEDICARE PLUS BLUE
MI
05
—
3493121
—
MI
01
—
410037242
RAILROAD MEDICARE
MI
01
—
900A665060
BCBS
MI
Enumeration date
11/01/2006
Last updated
12/15/2022
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