Healthcare Provider Details

I. General information

NPI: 1275454134
Provider Name (Legal Business Name): MATTHEW WILLIAMS OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 E ONTARIO ST
CHICAGO IL
60611-3385
US

IV. Provider business mailing address

711 W BROMPTON AVE APT 48
CHICAGO IL
60657-1884
US

V. Phone/Fax

Practice location:
  • Phone: 312-643-2019
  • Fax:
Mailing address:
  • Phone:
  • Fax: 312-643-2040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number046.012134
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: