Healthcare Provider Details

I. General information

NPI: 1780118802
Provider Name (Legal Business Name): MARK TONY WILLIAMS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2017
Last Update Date: 03/11/2025
Certification Date: 02/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 W STEWART DR STE 303
ORANGE CA
92868-3838
US

IV. Provider business mailing address

PO BOX 14107
IRVINE CA
92623-4107
US

V. Phone/Fax

Practice location:
  • Phone: 714-738-4621
  • Fax: 714-409-0629
Mailing address:
  • Phone: 714-738-4621
  • Fax: 714-409-0629

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberA187615
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License NumberA187615
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: