Healthcare Provider Details

I. General information

NPI: 1881614022
Provider Name (Legal Business Name): JILL L WILLIAMSON OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 05/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1614 N GREEN RIVER RD
EVANSVILLE IN
47715-1902
US

IV. Provider business mailing address

1614 N GREEN RIVER RD
EVANSVILLE IN
47715-1902
US

V. Phone/Fax

Practice location:
  • Phone: 812-618-0423
  • Fax: 812-618-2866
Mailing address:
  • Phone: 812-618-0423
  • Fax: 812-618-2866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2005020671
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number046.009784
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number18003661A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: