Individual
WILLIAM R PEDERSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OD0000000552
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2005369
BLUE CROSS BLUE SHIELD
TN
01
—
602004601
CARITEN
—
01
—
620927830
UNITED HEALTHCARE
—
Enumeration date
07/20/2005
Last updated
09/15/2014
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