Provider Demographics
NPI:1063987618
Name:WILLIAMS, STEPHEN (OPTICIAN)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 COMMERCE ST STE 629
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75202-4522
Mailing Address - Country:US
Mailing Address - Phone:469-583-4479
Mailing Address - Fax:
Practice Address - Street 1:701 COMMERCE ST STE 629
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75202-4522
Practice Address - Country:US
Practice Address - Phone:469-583-4479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-10
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician