MEDICARE: FREDERICK D. WILLIAMS, MD, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	156FX1100X	Ophthalmic Technician/Technologist	G41755	CA

General Provider Information

NPI Number	:	1427426154
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FREDERICK D. WILLIAMS, MD, INC.

Provider Business Mailing Address
First Line	:	1506 CENTINELA AVE
Second Line	:
City	:	INGLEWOOD
State	:	CA
Zip	:	90302-1144
Country	:	US
Telephone Number	:	310-419-5075
Fax Number	:

Provider Business Practice Location Address
First Line	:	1506 CENTINELA AVE
Second Line	:
City	:	INGLEWOOD
State	:	CA
Zip	:	90302-1144
Country	:	US
Telephone Number	:	310-419-5075
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. FREDERICK D. WILLIAMS
Credential	:	M.D.
Telephone Number	:	310-419-5075

Provider Enumeration Date	:	09/11/2015
Last Update Date	:	09/11/2015

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