Healthcare Provider Details

I. General information

NPI: 1255331427
Provider Name (Legal Business Name): ERNEST THOMAS WILLIAMS JR. O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 04/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2932 1ST AVE
HIBBING MN
55746-2564
US

IV. Provider business mailing address

2932 1ST AVE
HIBBING MN
55746-2564
US

V. Phone/Fax

Practice location:
  • Phone: 218-262-5686
  • Fax: 218-263-6938
Mailing address:
  • Phone: 218-262-5686
  • Fax: 218-263-6938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1568
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: