Healthcare Provider Details

I. General information

NPI: 1902802895
Provider Name (Legal Business Name): BRIAN F WILLIAMS O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2005
Last Update Date: 06/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10010 E. 81ST ST #100
TULSA OK
74133-5726
US

IV. Provider business mailing address

10010 E. 81ST ST #100
TULSA OK
74133-5726
US

V. Phone/Fax

Practice location:
  • Phone: 918-250-2020
  • Fax: 918-250-8910
Mailing address:
  • Phone: 918-250-2020
  • Fax: 918-250-8910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2147
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: