Healthcare Provider Details

I. General information

NPI: 1326820689
Provider Name (Legal Business Name): WILLIAMS OPHTHALMOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2023
Last Update Date: 06/03/2024
Certification Date: 06/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26771 W 12 MILE RD STE 110
SOUTHFIELD MI
48034-1539
US

IV. Provider business mailing address

26771 W 12 MILE RD STE 110
SOUTHFIELD MI
48034-1539
US

V. Phone/Fax

Practice location:
  • Phone: 248-621-3393
  • Fax: 248-621-2622
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207WX0109X
TaxonomyNeuro-ophthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: VICTORIA A WILLIAMS
Title or Position: OWNER
Credential: DO
Phone: 248-327-7398