Provider Demographics
NPI:1306922125
Name:WILLIAMS, TERRY L (OD)
Entity type:Individual
Prefix:DR
First Name:TERRY
Middle Name:L
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 WHEELING AVE
Mailing Address - Street 2:
Mailing Address - City:GLEN DALE
Mailing Address - State:WV
Mailing Address - Zip Code:26038-1529
Mailing Address - Country:US
Mailing Address - Phone:304-843-1445
Mailing Address - Fax:
Practice Address - Street 1:12 WHEELING AVE
Practice Address - Street 2:
Practice Address - City:GLEN DALE
Practice Address - State:WV
Practice Address - Zip Code:26038-1529
Practice Address - Country:US
Practice Address - Phone:304-843-1445
Practice Address - Fax:304-843-1446
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV645-D152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV645OtherHEALTH PLAN
WV001720254OtherMOUNTAIN STATE BLUE CROSS
WV410000871OtherRAILROAD MEDICARE
WV4251461Medicare PIN
WVT32542Medicare UPIN
WV001720254OtherMOUNTAIN STATE BLUE CROSS
WV645OtherHEALTH PLAN