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General NPI Number Information
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NPI Number | 1679170641
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Entity Type | Individual
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Provider Name | JOSEPH C MCWILLIAMS
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Gender | Male
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Dates
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Enumeration Date | 10/02/2020
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Last Update Date | 10/02/2020
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Provider Practice Location Address
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Address Line | 29 COLLEGE RD STE 14
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City | FAIRBANKS
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State | AK
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Zip | 99701-1739
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Country | US
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Telephone | 907-590-1821
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 30032
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City | CENTRAL
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State | AK
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Zip | 99730-0032
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Country | US
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Telephone | 907-520-5496
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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 | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 2110250
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License Number State | AK
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