Provider Demographics
NPI:1821290222
Name:WILLIAMS, THOMAS EDWARD (CAHA1541)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:EDWARD
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:CAHA1541
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2353 CONCORD BLVD
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94520-2108
Mailing Address - Country:US
Mailing Address - Phone:925-687-3211
Mailing Address - Fax:925-685-2097
Practice Address - Street 1:2353 CONCORD BLVD
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-2108
Practice Address - Country:US
Practice Address - Phone:925-687-3211
Practice Address - Fax:925-685-2097
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACAHA1541332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment