Healthcare Provider Details

I. General information

NPI: 1346296043
Provider Name (Legal Business Name): GARY LESTER WILLIAMS O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 09/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1124 KEMPER MEADOW DR
CINCINNATI OH
45240-4117
US

IV. Provider business mailing address

1124 KEMPER MEADOW DR
CINCINNATI OH
45240-4117
US

V. Phone/Fax

Practice location:
  • Phone: 513-851-2414
  • Fax: 513-851-6159
Mailing address:
  • Phone: 513-851-2414
  • Fax: 513-851-6159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOH3097
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: