Provider Demographics
NPI:1508056623
Name:WILLIAMS, HERBERT FLOYD JR (OD)
Entity Type:Individual
Prefix:DR
First Name:HERBERT
Middle Name:FLOYD
Last Name:WILLIAMS
Suffix:JR
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 8203
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75404-8203
Mailing Address - Country:US
Mailing Address - Phone:903-455-0294
Mailing Address - Fax:903-455-2747
Practice Address - Street 1:5200 WESLEY ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75402
Practice Address - Country:US
Practice Address - Phone:903-455-0294
Practice Address - Fax:903-455-2747
Is Sole Proprietor?:No
Enumeration Date:2007-07-25
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2187TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXT16632Medicare UPIN
8A7677Medicare Oscar/Certification
TX00320VMedicare PIN
TX4708550001Medicare NSC