1205070232 NPI number — DR. ERNEST T. WILLIAMS JR., OPTOMETRIST

Table of content: (NPI 1205070232)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205070232 NPI number — DR. ERNEST T. WILLIAMS JR., OPTOMETRIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR. ERNEST T. WILLIAMS JR., OPTOMETRIST
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205070232
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/10/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2932 1ST AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HIBBING
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55746-2564
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
218-262-5686
Provider Business Mailing Address Fax Number:
218-263-6938

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2932 1ST AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HIBBING
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55746-2564
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-262-5686
Provider Business Practice Location Address Fax Number:
218-263-6938
Provider Enumeration Date:
04/21/2009

Additional Information

Authorized Official

Authorized Official Last Name:
WILLIAMS
Authorized Official First Name:
ERNEST
Authorized Official Middle Name:
THOMAS
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
218-262-5686

Provider Taxonomy Codes

  • Taxonomy code: 332H00000X , with the licence number:  1568 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2200989 . This is a "MEDICA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 111185 . This is a "U CARE EYEGLASSES" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 170174 . This is a "U CARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 914323800 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01009882 . This is a "PREFERRED ONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 4C990WI . This is a "BLUE CROSS/BLUE SHIELD EYEGLASSES" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 2111187 . This is a "MEDICA EYEGLASSES" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 61443WI . This is a "BLUE CROSS/ BLUE SHIELD OF MN" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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