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General NPI Number Information
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NPI Number | 1205070232
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Entity Type | Organization
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Legal Business Name | DR. ERNEST T. WILLIAMS JR., OPTOMETRIST
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Dates
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Enumeration Date | 04/21/2009
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Last Update Date | 12/10/2009
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Provider Practice Location Address
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Address Line | 2932 1ST AVE
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City | HIBBING
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State | MN
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Zip | 55746-2564
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Country | US
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Telephone | 218-262-5686
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Fax | 218-263-6938
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Provider Business Mailing Address
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Address Line | 2932 1ST AVE
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City | HIBBING
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State | MN
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Zip | 55746-2564
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Country | US
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Telephone | 218-262-5686
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Fax | 218-263-6938
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Authorized Official
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Title or Position | OWNER
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Name | DR. ERNEST THOMAS WILLIAMS II
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Credential | O.D.
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Telephone | 218-262-5686
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 1568
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License Number State | MN
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