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General NPI Number Information
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NPI Number | 1942619275
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Entity Type | Individual
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Provider Name | BLAKE THOMAS WILLIAMS O.D.
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Gender | Male
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Dates
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Enumeration Date | 08/12/2014
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Last Update Date | 08/09/2023
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Provider Practice Location Address
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Address Line | 2394 H G MOSLEY PKWY
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City | LONGVIEW
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State | TX
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Zip | 75604-3661
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Country | US
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Telephone | 903-234-0771
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Fax | 903-234-0775
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Provider Business Mailing Address
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Address Line | 2394 H G MOSLEY PKWY
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City | LONGVIEW
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State | TX
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Zip | 75604-3661
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Country | US
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Telephone | 903-234-0771
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Fax | 903-234-0775
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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 | 8513T
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License Number State | TX
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