Provider Demographics
NPI:1205070232
Name:DR. ERNEST T. WILLIAMS JR., OPTOMETRIST
Entity type:Organization
Organization Name:DR. ERNEST T. WILLIAMS JR., OPTOMETRIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERNEST
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:II
Authorized Official - Credentials:OD
Authorized Official - Phone:218-262-5686
Mailing Address - Street 1:2932 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:HIBBING
Mailing Address - State:MN
Mailing Address - Zip Code:55746-2564
Mailing Address - Country:US
Mailing Address - Phone:218-262-5686
Mailing Address - Fax:218-263-6938
Practice Address - Street 1:2932 1ST AVE
Practice Address - Street 2:
Practice Address - City:HIBBING
Practice Address - State:MN
Practice Address - Zip Code:55746-2564
Practice Address - Country:US
Practice Address - Phone:218-262-5686
Practice Address - Fax:218-263-6938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-21
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1568332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN2200989OtherMEDICA
MN111185OtherU CARE EYEGLASSES
MN170174OtherU CARE
MN914323800Medicaid
MN01009882OtherPREFERRED ONE
MN4C990WIOtherBLUE CROSS/BLUE SHIELD EYEGLASSES
MN2111187OtherMEDICA EYEGLASSES
MN61443WIOtherBLUE CROSS/ BLUE SHIELD OF MN
MN914323800Medicaid
MN01009882OtherPREFERRED ONE
MNT66295Medicare UPIN