Provider Demographics
NPI:1477666717
Name:WILLIAMS, GARY LELAND (OD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:LELAND
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:4900 COMMERCE DR
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-0418
Mailing Address - Country:US
Mailing Address - Phone:661-325-7791
Mailing Address - Fax:661-325-6724
Practice Address - Street 1:4900 COMMERCE DR
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-0418
Practice Address - Country:US
Practice Address - Phone:661-325-7791
Practice Address - Fax:661-325-6724
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4476T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1477666717OtherNPI
0581130001Medicare NSC
CA1477666717OtherNPI
T88808Medicare UPIN