Healthcare Provider Details

I. General information

NPI: 1720498983
Provider Name (Legal Business Name): SKYLAR DAVIS WILLIAMS O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2014
Last Update Date: 03/03/2025
Certification Date: 03/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PSC 482 BOX 1600
FPO AP
96362-0017
US

IV. Provider business mailing address

PSC 482 BOX 1600
FPO AP
96362-0017
US

V. Phone/Fax

Practice location:
  • Phone: 315-646-7119
  • Fax:
Mailing address:
  • Phone: 315-646-7119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2833
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: