Provider Demographics
NPI:1760572283
Name:WILLIAMS, THOMAS J (OD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:J
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:PO BOX 910
Mailing Address - Street 2:
Mailing Address - City:DURANT
Mailing Address - State:OK
Mailing Address - Zip Code:74702-0910
Mailing Address - Country:US
Mailing Address - Phone:580-924-2730
Mailing Address - Fax:580-924-2731
Practice Address - Street 1:203 N 16TH AVE
Practice Address - Street 2:
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701-3607
Practice Address - Country:US
Practice Address - Phone:580-924-2730
Practice Address - Fax:580-924-2731
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK903152W00000X, 152WL0500X, 152WC0802X, 152WP0200X, 152WS0006X, 152WV0400X, 152WX0102X, 156FX1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
No156FX1101XEye and Vision Services ProvidersTechnician/TechnologistOphthalmic Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK731004924-001OtherBLUE CROSS BLUE SHIELD
OK731004927OtherBLUE CROSS BLUE SHIELD
OK100765480AMedicaid
OKT78444Medicare UPIN