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General NPI Number Information
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NPI Number | 1639142946
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Entity Type | Individual
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Provider Name | GARY J WILLIAMS OD
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Gender | Male
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Dates
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Enumeration Date | 02/08/2006
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Last Update Date | 04/19/2017
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Provider Practice Location Address
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Address Line | 293 MAIN ST
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City | OWEGO
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State | NY
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Zip | 13827-1615
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Country | US
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Telephone | 607-687-3391
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Fax | 607-687-4226
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Provider Business Mailing Address
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Address Line | 293 MAIN ST
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City | OWEGO
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State | NY
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Zip | 13827-1615
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Country | US
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Telephone | 607-687-3391
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Fax | 607-687-4226
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 3216
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License Number State | NY
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