Provider Demographics
NPI:1952969859
Name:WILLIAMS, LAREZIA DENISE (OD)
Entity Type:Individual
Prefix:DR
First Name:LAREZIA
Middle Name:DENISE
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:PO BOX 55041
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35255-5041
Mailing Address - Country:US
Mailing Address - Phone:334-669-0515
Mailing Address - Fax:
Practice Address - Street 1:3595 GRANDVIEW PKWY STE 125
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35243-1816
Practice Address - Country:US
Practice Address - Phone:205-968-6526
Practice Address - Fax:205-298-6078
Is Sole Proprietor?:No
Enumeration Date:2019-06-05
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS-E24-TA-B56152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist