MEDICARE: DR. GRADY JOSEPH WILLIAMS O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	NV296	NV

General Provider Information

NPI Number	:	1346266095
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GRADY JOSEPH WILLIAMS O.D.

Provider Business Mailing Address
First Line	:	5724 DESERT SKY WAY
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89149-5130
Country	:	US
Telephone Number	:	702-655-7476
Fax Number	:

Provider Business Practice Location Address
First Line	:	2400 W CHARLESTON BLVD
Second Line	:	SUITE D
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-2152
Country	:	US
Telephone Number	:	702-870-5911
Fax Number	:	702-870-2368

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	12/04/2008

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