Individual
LARRY EARL WILLIAMS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
10 AMALIA DR, SUITE C1, BUCKHANNON, WV 26201-2271
(304) 472-9160
Mailing address
10 AMALIA DR, SUITE C1, BUCKHANNON, WV 26201-2271
(304) 472-9160
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
683 ODWV
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001719808
BLUE CROSS BLUE SHIELD
WV
01
—
1034014
UMWA
WV
01
—
410019766
RAILROAD MEDICARE
WV
Enumeration date
08/24/2006
Last updated
12/19/2007
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