Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 3500 | CO |
NPI | 1003477555 |
---|---|
Provider Name | Brian Richard Williams |
First Address | Aurora, CO 80012-3692 |
Second Address | Aurora, CO 80012-3692 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2019 |
Last Update Date | 17/10/2019 |