Provider Demographics
NPI:1942983465
Name:WILLIGER, MAX MALCOLM (OD)
Entity type:Individual
Prefix:
First Name:MAX
Middle Name:MALCOLM
Last Name:WILLIGER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 WESTHAMPTON STA
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-3330
Mailing Address - Country:US
Mailing Address - Phone:804-287-4200
Mailing Address - Fax:804-282-4048
Practice Address - Street 1:6946 FOREST AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-1706
Practice Address - Country:US
Practice Address - Phone:804-287-2020
Practice Address - Fax:804-282-4048
Is Sole Proprietor?:No
Enumeration Date:2023-08-10
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009891152W00000X
VA0618003397152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist