Provider Demographics
NPI:1609874783
Name:WILLIAMS, RUSSELL K (OD)
Entity Type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:K
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2480 S DOWNING ST
Mailing Address - Street 2:SUITE G-30
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-5890
Mailing Address - Country:US
Mailing Address - Phone:303-777-3277
Mailing Address - Fax:303-698-9713
Practice Address - Street 1:2480 S DOWNING ST
Practice Address - Street 2:SUITE G-30
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-5890
Practice Address - Country:US
Practice Address - Phone:303-777-3277
Practice Address - Fax:303-698-9713
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2091152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COMW0575689OtherDEA
D8795Medicare UPIN
COMW0575689OtherDEA