Provider Demographics
NPI:1720838873
Name:WILLIAMS, WALTER KEANDRE DESEAN IV (OD)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:KEANDRE DESEAN
Last Name:WILLIAMS
Suffix:IV
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:WALT
Other - Middle Name:
Other - Last Name:WILLIAMS
Other - Suffix:IV
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3734 LAUDERDALE DR
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-1154
Mailing Address - Country:US
Mailing Address - Phone:419-944-0565
Mailing Address - Fax:
Practice Address - Street 1:3734 LAUDERDALE DR
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-1154
Practice Address - Country:US
Practice Address - Phone:419-944-0565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-22
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program