Provider Demographics
NPI:1598758559
Name:WILLIAMS, PAUL A (OD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
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 1:223 140TH ST S STE 500
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98444-4548
Mailing Address - Country:US
Mailing Address - Phone:360-561-9147
Mailing Address - Fax:253-535-4888
Practice Address - Street 1:223 140TH ST S STE 500
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98444-4548
Practice Address - Country:US
Practice Address - Phone:360-561-9147
Practice Address - Fax:253-535-4888
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-25
Last Update Date:2022-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00003435152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2021749Medicaid
WAU41315Medicare UPIN