Basic Information
| Provider Information | |||||||||
| NPI: | 1952969859 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WILLIAMS | ||||||||
| FirstName: | LAREZIA | ||||||||
| MiddleName: | DENISE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | OD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 55041 | ||||||||
| Address2: | |||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352555041 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3346690515 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3595 GRANDVIEW PKWY STE 125 | ||||||||
| Address2: | |||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352431816 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2059686526 | ||||||||
| FaxNumber: | 2052986078 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2019 | ||||||||
| LastUpdateDate: | 08/09/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | S-E24-TA-B56 | AL | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.