Provider Demographics
NPI:1467459511
Name:WILLIAMS, PHILIP THOMAS (OD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:THOMAS
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 1:17432 SMOKEY POINT BLVD
Mailing Address - Street 2:SUITE #102
Mailing Address - City:ARLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98223-8784
Mailing Address - Country:US
Mailing Address - Phone:360-653-3305
Mailing Address - Fax:360-658-0812
Practice Address - Street 1:17432 SMOKEY POINT BLVD
Practice Address - Street 2:SUITE #102
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-8784
Practice Address - Country:US
Practice Address - Phone:360-653-3305
Practice Address - Fax:360-658-0812
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-05
Last Update Date:2018-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1527TX152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2003903Medicaid
WA001200814Medicare ID - Type Unspecified
WA2003903Medicaid
WAT03071Medicare UPIN