=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639171291
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROBERT DEAN WILLIAMS MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/12/2005
-----------------------------------------------------
Last Update Date | 03/28/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 470 SPRING STREET STE 200
-----------------------------------------------------
City | FRIDAY HARBOR
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98250
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-378-3937
-----------------------------------------------------
Fax | 360-282-6871
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 89 WILKS WAY
-----------------------------------------------------
City | FRIDAY HARBOR
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98250-6049
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-458-9004
-----------------------------------------------------
Fax | 360-282-6871
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | 27856
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | 01042740
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | MD00015265
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------