Provider Demographics
NPI:1639171291
Name:WILLIAMS, ROBERT DEAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:DEAN
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89 WILKS WAY
Mailing Address - Street 2:
Mailing Address - City:FRIDAY HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98250-6049
Mailing Address - Country:US
Mailing Address - Phone:502-458-9004
Mailing Address - Fax:360-282-6871
Practice Address - Street 1:470 SPRING STREET
Practice Address - Street 2:STE 200
Practice Address - City:FRIDAY HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98250
Practice Address - Country:US
Practice Address - Phone:360-378-3937
Practice Address - Fax:360-282-6871
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-12
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY27856207W00000X
IN01042740207W00000X
WAMD00015265207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY180019058OtherMEDICARE RAILROAD
0800308OtherUNITED HEALTHCARE
IN100380330AMedicaid
KYK001342OtherTRICARE
KY1051979Medicaid
KY000000062218OtherANTHEM
IN100380300BMedicaid
4227781OtherAETNA
917224OtherBLOCK VISION
KY64278567Medicaid
IN000000042394OtherANTHEM
IN180017926OtherMEDICARE RAILROAD
INI005632OtherTRICARE
IN000000042394OtherANTHEM
KYK001342OtherTRICARE
917224OtherBLOCK VISION