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General NPI Number Information
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NPI Number | 1265502272
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Entity Type | Organization
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Legal Business Name | JEFFREY W. WILLIAMS, O.D. & ASSOCIATES, PA
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Dates
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Enumeration Date | 11/08/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 302 S KNOWLES AVE
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City | NEW RICHMOND
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State | WI
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Zip | 54017-1731
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Country | US
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Telephone | 715-246-2419
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Fax | 715-246-9434
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Provider Business Mailing Address
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Address Line | 3480 BUNKER LAKE BLVD NW
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City | ANDOVER
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State | MN
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Zip | 55304-2085
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Country | US
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Telephone | 763-712-9854
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Fax | 763-506-9962
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JEFFREY W. WILLIAMS
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Credential | O.D.
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Telephone | 763-712-9854
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 1038
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License Number State | WI
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