Provider Demographics
NPI:1104835636
Name:WILLIAMS, SHARON L (OD)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:L
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1708 YAKIMA AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-5307
Mailing Address - Country:US
Mailing Address - Phone:253-502-5965
Mailing Address - Fax:253-593-8410
Practice Address - Street 1:1708 YAKIMA AVE
Practice Address - Street 2:STE 100
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-5307
Practice Address - Country:US
Practice Address - Phone:253-502-5965
Practice Address - Fax:253-593-8410
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2015-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00001896152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0167395OtherSTATE L&I
WA410039557OtherRAILROAD
WA8934255OtherSTATE CRIME VICTIMS
WA0126526OtherSTATE L&I
WA2011989Medicaid
WA8928708OtherSTATE CRIME VICTIMS
WAGAB08491Medicare PIN
WA0167395OtherSTATE L&I
WA2011989Medicaid