Provider Demographics
NPI:1275708224
Name:WILLIAMS, ALTON ALLEN (OD)
Entity Type:Individual
Prefix:DR
First Name:ALTON
Middle Name:ALLEN
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 1:100 CHRISTIANA MEDICAL CTR
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-1697
Mailing Address - Country:US
Mailing Address - Phone:302-283-1988
Mailing Address - Fax:302-283-1991
Practice Address - Street 1:100 CHRISTIANA MEDICAL CTR
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19702-1697
Practice Address - Country:US
Practice Address - Phone:302-283-1988
Practice Address - Fax:302-283-1991
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE1132152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000701922Medicaid
DE410037570OtherRAILROAD MEDICARE
DET6963Medicare UPIN