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NPI Code Detail

MEDICARE: TERRY WILLIAMS OD

MEDICARE: TERRY WILLIAMS OD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist05792CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1811990591
Entity Type Code : Individual
Provider Name (Legal Business Name) : TERRY WILLIAMS OD
Provider Business Mailing Address
First Line : 1517 S OREGON ST
Second Line :
City : YREKA
State : CA
Zip : 96097-3425
Country : US
Telephone Number : 530-842-5705
Fax Number : 530-842-3061
Provider Business Practice Location Address
First Line : 1517 S OREGON ST
Second Line :
City : YREKA
State : CA
Zip : 96097-3425
Country : US
Telephone Number : 530-842-5705
Fax Number : 530-842-3061
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/24/2005
Last Update Date : 07/06/2010

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