Provider Demographics
NPI:1710072491
Name:WILLIAMS, ANDREW L (OD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:L
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 1:681 CRANBERRY ST
Mailing Address - Street 2:P.O. BOX 880
Mailing Address - City:NEWLAND
Mailing Address - State:NC
Mailing Address - Zip Code:28657-8801
Mailing Address - Country:US
Mailing Address - Phone:828-733-2011
Mailing Address - Fax:828-733-6177
Practice Address - Street 1:681 CRANBERRY ST
Practice Address - Street 2:
Practice Address - City:NEWLAND
Practice Address - State:NC
Practice Address - Zip Code:28657-8801
Practice Address - Country:US
Practice Address - Phone:828-733-2011
Practice Address - Fax:828-733-6177
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC1404152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC09143OtherBLUE CROSS/BLUE SHIELDS
NC22-71114OtherUNITED HEALTH CARE
NC890903JMedicaid
NC2467915AMedicare PIN
NC890903JMedicaid