Healthcare Provider Details

I. General information

NPI: 1912825639
Provider Name (Legal Business Name): MARY ELIZABETH WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8808 BEACH BLVD
JACKSONVILLE FL
32216-4600
US

IV. Provider business mailing address

8808 BEACH BLVD
JACKSONVILLE FL
32216-4600
US

V. Phone/Fax

Practice location:
  • Phone: 904-641-1963
  • Fax: 904-641-1240
Mailing address:
  • Phone: 904-641-1963
  • Fax: 904-641-1240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License NumberDO6581
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: