Healthcare Provider Details

I. General information

NPI: 1548424302
Provider Name (Legal Business Name): JEFFREY S. WILLIAMS, JR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2008
Last Update Date: 07/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 E MAIN ST
RIVERHEAD NY
11901-2404
US

IV. Provider business mailing address

307 E MAIN ST
RIVERHEAD NY
11901-2404
US

V. Phone/Fax

Practice location:
  • Phone: 631-727-2858
  • Fax: 631-727-2866
Mailing address:
  • Phone: 631-727-2858
  • Fax: 631-727-2866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License NumberTUV007157
License Number StateNY

VIII. Authorized Official

Name: DR. JEFFREY SLANEY WILLIAMS JR.
Title or Position: OWNER
Credential: O.D.
Phone: 631-727-2858