Provider Demographics
NPI:1326122599
Name:WILLIAMS, COURTNEY CONSTANTINE (OD)
Entity Type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:CONSTANTINE
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9440 NE 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI SHORES
Mailing Address - State:FL
Mailing Address - Zip Code:33138-2703
Mailing Address - Country:US
Mailing Address - Phone:786-313-3048
Mailing Address - Fax:786-313-3051
Practice Address - Street 1:9440 NE 2ND AVE
Practice Address - Street 2:
Practice Address - City:MIAMI SHORES
Practice Address - State:FL
Practice Address - Zip Code:33138-2703
Practice Address - Country:US
Practice Address - Phone:786-313-3048
Practice Address - Fax:786-313-3051
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 3388152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist