Provider Demographics
NPI:1649274457
Name:WILLIAMS, CECILIA PURSEL (OD)
Entity type:Individual
Prefix:DR
First Name:CECILIA
Middle Name:PURSEL
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7241 COMMERCE ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22150-3411
Mailing Address - Country:US
Mailing Address - Phone:703-866-9364
Mailing Address - Fax:703-866-9198
Practice Address - Street 1:7241 COMMERCE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22150-3411
Practice Address - Country:US
Practice Address - Phone:703-866-9364
Practice Address - Fax:703-866-9198
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000529152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAT31132Medicare UPIN
408969Medicare ID - Type Unspecified