Provider Demographics
NPI:1568432631
Name:WILLIAMS, EDWARD A (OD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:A
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 1:835 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:CA
Mailing Address - Zip Code:94553-1225
Mailing Address - Country:US
Mailing Address - Phone:925-228-3737
Mailing Address - Fax:925-228-3708
Practice Address - Street 1:835 MAIN ST
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:CA
Practice Address - Zip Code:94553-1225
Practice Address - Country:US
Practice Address - Phone:925-228-3737
Practice Address - Fax:925-228-3708
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7088T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
503048001Medicare ID - Type UnspecifiedCIGNA MEDICARE
SD0070880Medicare ID - Type UnspecifiedBLUE SHIELD MEDICARE