Provider Demographics
NPI:1073527206
Name:WILLIAMS, EDWARD P (OD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:P
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 1:123 MADISON ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-5434
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:123 MADISON ST
Practice Address - Street 2:SUITE 100
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-5434
Practice Address - Country:US
Practice Address - Phone:303-355-6111
Practice Address - Fax:303-355-0388
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1286152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC42483OtherMEDICARE GROUP PTAN
CO1982888525OtherGROUP NPI
CO1982888525OtherGROUP NPI
COP00119803Medicare PIN
COC42483OtherMEDICARE GROUP PTAN