Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 903 | OK |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 903 | OK |
N | 152WL0500X | Optomitrist - Low Vision Rehabilitation | 903 | OK |
N | 152WP0200X | Pediatric Optomitrist | 903 | OK |
N | 152WS0006X | Sports Vision | 903 | OK |
N | 152WV0400X | Optomitrist - Vision Therapist | 903 | OK |
N | 152WX0102X | Occupational Vision | 903 | OK |
N | 156FX1101X | Ophthalmic Assistant | 903 | OK |
NPI | 1760572283 |
---|---|
Provider Name | Dr. Thomas J. Williams |
First Address | Durant, OK 74702-0910 |
Second Address | Durant, OK 74701-3607 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2006 |
Last Update Date | 02/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100765480A | (05) | OK |
731004924-001 | BLUE CROSS BLUE SHIELD (01) | OK |
731004927 | BLUE CROSS BLUE SHIELD (01) | OK |
T78444 | (02) | OK |