Provider Demographics
NPI:1598736928
Name:WILLIAMS, BENJAMIN ERIC (OD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:ERIC
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 1:301 S IOWA AVE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52353-1747
Mailing Address - Country:US
Mailing Address - Phone:319-653-2371
Mailing Address - Fax:319-653-6070
Practice Address - Street 1:301 S IOWA AVE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:IA
Practice Address - Zip Code:52353-1747
Practice Address - Country:US
Practice Address - Phone:319-653-2371
Practice Address - Fax:319-653-6070
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02265152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1297176Medicaid
IA1297176Medicaid
IA16939Medicare PIN
IA96194Medicare UPIN