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General NPI Number Information
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NPI Number | 1245378496
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Entity Type | Organization
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Legal Business Name | WILLIAMS EYECARE GROUP LLC
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Dates
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Enumeration Date | 02/01/2007
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Last Update Date | 10/11/2012
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Provider Practice Location Address
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Address Line | 3250 GATEWAY BLVD STE 152
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City | PRESCOTT
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State | AZ
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Zip | 86303-6857
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Country | US
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Telephone | 928-442-9202
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Fax | 928-442-3980
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Provider Business Mailing Address
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Address Line | 3250 GATEWAY BLVD STE 152
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City | PRESCOTT
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State | AZ
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Zip | 86303-6857
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Country | US
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Telephone | 928-442-9202
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Fax | 928-442-3980
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Authorized Official
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Title or Position | OWNER, OD
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Name | DR. KENNETH W WILLIAMS
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Credential | O.D.
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Telephone | 928-442-9202
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 01119
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License Number State | AZ
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