Provider Demographics
NPI:1689671463
Name:WILLIAMS, ERIC Q (OD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:Q
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1209 YORK RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-6207
Mailing Address - Country:US
Mailing Address - Phone:410-821-9490
Mailing Address - Fax:410-821-9495
Practice Address - Street 1:1209 YORK RD
Practice Address - Street 2:SUITE 200
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-6207
Practice Address - Country:US
Practice Address - Phone:410-821-9490
Practice Address - Fax:410-821-9495
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA1590152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD741300900Medicaid
MDU76262Medicare UPIN
MDS049804YMedicare ID - Type Unspecified