Healthcare Provider Details

I. General information

NPI: 1851886865
Provider Name (Legal Business Name): NICOLE AMANDA WILLIAMS OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2018
Last Update Date: 06/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 SULLIVAN TRL
EASTON PA
18040-8354
US

IV. Provider business mailing address

147 S 4TH ST APT 5
EASTON PA
18042-4489
US

V. Phone/Fax

Practice location:
  • Phone: 610-258-6666
  • Fax:
Mailing address:
  • Phone: 862-266-7497
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG003408
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberOEG003408
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: