Provider Demographics
NPI:1417940560
Name:WILLIAMS, RANDY MICHAEL (OD)
Entity Type:Individual
Prefix:
First Name:RANDY
Middle Name:MICHAEL
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 1:581 SECOND ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03102-5200
Mailing Address - Country:US
Mailing Address - Phone:603-668-2010
Mailing Address - Fax:603-668-3944
Practice Address - Street 1:581 SECOND ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03102-5200
Practice Address - Country:US
Practice Address - Phone:603-668-2010
Practice Address - Fax:603-668-3944
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH610152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RE2867Medicare ID - Type Unspecified
U45594Medicare UPIN