Provider Demographics
NPI:1942793294
Name:WILLIAMS, DEREK (OD)
Entity Type:Individual
Prefix:DR
First Name:DEREK
Middle Name:
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 1:4123 WORTH RD
Mailing Address - Street 2:
Mailing Address - City:PINCONNING
Mailing Address - State:MI
Mailing Address - Zip Code:48650-8316
Mailing Address - Country:US
Mailing Address - Phone:989-313-1006
Mailing Address - Fax:
Practice Address - Street 1:1522 JANES AVE
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48601-1819
Practice Address - Country:US
Practice Address - Phone:989-907-2790
Practice Address - Fax:989-399-8263
Is Sole Proprietor?:No
Enumeration Date:2018-06-12
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901005110152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist