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General NPI Number Information
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NPI Number | 1548424302
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Entity Type | Organization
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Legal Business Name | JEFFREY S. WILLIAMS, JR
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Dates
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Enumeration Date | 07/10/2008
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Last Update Date | 07/10/2008
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Provider Practice Location Address
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Address Line | 307 E MAIN ST
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City | RIVERHEAD
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State | NY
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Zip | 11901-2404
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Country | US
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Telephone | 631-727-2858
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Fax | 631-727-2866
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Provider Business Mailing Address
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Address Line | 307 E MAIN ST
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City | RIVERHEAD
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State | NY
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Zip | 11901-2404
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Country | US
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Telephone | 631-727-2858
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Fax | 631-727-2866
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Authorized Official
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Title or Position | OWNER
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Name | DR. JEFFREY SLANEY WILLIAMS JR.
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Credential | O.D.
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Telephone | 631-727-2858
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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 | TUV007157
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License Number State | NY
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