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General NPI Number Information
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NPI Number | 1730704172
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Entity Type | Individual
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Provider Name | BRET RICHARD WILLIAMS O.D.
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Gender | Male
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Dates
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Enumeration Date | 06/11/2020
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Last Update Date | 11/14/2024
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Provider Practice Location Address
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Address Line | 1000 PINE GROVE AVE
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City | PORT HURON
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State | MI
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Zip | 48060-3733
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Country | US
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Telephone | 810-982-3200
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Fax | 810-982-4480
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Provider Business Mailing Address
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Address Line | 24307 HARPER AVE
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City | SAINT CLAIR SHORES
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State | MI
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Zip | 48080-1271
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Country | US
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Telephone | 586-775-6733
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Fax | 586-775-0397
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 4901005435
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License Number State | MI
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