Healthcare Provider Details

I. General information

NPI: 1427043652
Provider Name (Legal Business Name): ELWOOD WILLIAMS OPTICIAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: WOODY WILLIAMS OPTICIAN

II. Dates (important events)

Enumeration Date: 09/14/2005
Last Update Date: 09/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 TOWNE BLVD SUITE B
FRANKLIN OH
45005-5543
US

IV. Provider business mailing address

3600 TOWNE BLVD SUITE B
FRANKLIN OH
45005-5543
US

V. Phone/Fax

Practice location:
  • Phone: 513-424-5217
  • Fax: 513-424-0205
Mailing address:
  • Phone: 513-424-5217
  • Fax: 513-424-0205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number2467SC
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: