Provider Demographics
NPI:1255331427
Name:WILLIAMS, ERNEST THOMAS JR (OD)
Entity Type:Individual
Prefix:DR
First Name:ERNEST
Middle Name:THOMAS
Last Name:WILLIAMS
Suffix:JR
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 1:2932 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:HIBBING
Mailing Address - State:MN
Mailing Address - Zip Code:55746-2564
Mailing Address - Country:US
Mailing Address - Phone:218-262-5686
Mailing Address - Fax:218-263-6938
Practice Address - Street 1:2932 1ST AVE
Practice Address - Street 2:
Practice Address - City:HIBBING
Practice Address - State:MN
Practice Address - Zip Code:55746-2564
Practice Address - Country:US
Practice Address - Phone:218-262-5686
Practice Address - Fax:218-263-6938
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-28
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1568152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN2111187OtherMEDICA EYEGLASSES
MN4C990WIOtherBC/BS EYEGLASS & CL
MN61443WIOtherBLUE CROSS/BLUE SHIELD
MN914323800Medicaid
MN170174OtherUCARE
MN2200989OtherMEDICA
MNN005453OtherCHAMPUS
MN01009882OtherPREFERRED ONE
MN0313870001OtherD MERC
MN111185OtherUCARE EYEGLASSES
MN111185OtherUCARE EYEGLASSES
MN2200989OtherMEDICA
MNT66295Medicare UPIN