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General NPI Number Information
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NPI Number | 1104933258
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Entity Type | Individual
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Provider Name | JENNIFER WILLIAMS-MCDERMED O.D.
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Gender | Female
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Dates
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Enumeration Date | 08/24/2006
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Last Update Date | 08/16/2012
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Provider Practice Location Address
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Address Line | 12301 LAKE UNDERHILL RD SUITE 236
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City | ORLANDO
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State | FL
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Zip | 32828-4508
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Country | US
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Telephone | 407-277-5729
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Fax |
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Provider Business Mailing Address
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Address Line | 12301 LAKE UNDERHILL RD SUITE 236
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City | ORLANDO
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State | FL
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Zip | 32828-4508
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Country | US
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Telephone | 407-277-5729
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WP0200X
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Taxonomy Name | Pediatric Optometrist
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License Number | OPC 4185
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 152WS0006X
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Taxonomy Name | Sports Vision Optometrist
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License Number | OPC 4185
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 152WV0400X
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Taxonomy Name | Vision Therapy Optometrist
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License Number | OPC 4185
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License Number State | FL
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