Provider Demographics
NPI:1417054891
Name:ROSS H WILLIAMS OD, PC
Entity Type:Organization
Organization Name:ROSS H WILLIAMS OD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:K
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-230-1600
Mailing Address - Street 1:4067 E COURT ST
Mailing Address - Street 2:SIUTE 10
Mailing Address - City:BURTON
Mailing Address - State:MI
Mailing Address - Zip Code:48509-2509
Mailing Address - Country:US
Mailing Address - Phone:810-230-1600
Mailing Address - Fax:810-715-2027
Practice Address - Street 1:4067 E COURT ST
Practice Address - Street 2:SIUTE 10
Practice Address - City:BURTON
Practice Address - State:MI
Practice Address - Zip Code:48509-2509
Practice Address - Country:US
Practice Address - Phone:810-230-1600
Practice Address - Fax:810-715-2027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2008-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901002528152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4180865Medicaid
MI900B56569OtherBCBSM
MI4180865Medicaid
MIT32800Medicare UPIN
MI0531400001Medicare NSC