Provider Demographics
NPI:1841592227
Name:FREDERICK D. WILLIAMS, M.D., INC.
Entity Type:Organization
Organization Name:FREDERICK D. WILLIAMS, M.D., INC.
Other - Org Name:FREDERICK D. WILLIAMS, M.D.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:D
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-419-5075
Mailing Address - Street 1:1506 CENTINELA AVE
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90302-1144
Mailing Address - Country:US
Mailing Address - Phone:310-419-5075
Mailing Address - Fax:310-419-0520
Practice Address - Street 1:1506 CENTINELA AVE
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90302-1144
Practice Address - Country:US
Practice Address - Phone:310-419-5075
Practice Address - Fax:310-419-0520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-17
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG41755207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G417550Medicaid
CA00G417550Medicaid