Provider Demographics
NPI:1417933078
Name:WILLIAMS, ROBERT NEAL JR (OD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:NEAL
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 1:4885 SOCASTEE BLVD
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29588-7245
Mailing Address - Country:US
Mailing Address - Phone:843-293-8101
Mailing Address - Fax:843-293-8102
Practice Address - Street 1:4885 SOCASTEE BLVD
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29588-7245
Practice Address - Country:US
Practice Address - Phone:843-293-8101
Practice Address - Fax:843-293-8102
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC755152W00000X
NCNC1095152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNC1095OtherSTATE LICENSE
SCSC755OtherSTATE LICENSE
SCD00755Medicaid
NC89093JXMedicaid
SC4942510001Medicare NSC
SCT237870281Medicare PIN
SCD00755Medicaid
NC2471837Medicare PIN