MEDICARE: DR. JEFFREY SLANEY WILLIAMS SR. O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	3809	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	C29481	OTHER		MEDICARE ID

General Provider Information

NPI Number	:	1225024490
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY SLANEY WILLIAMS SR. O.D.

Provider Business Mailing Address
First Line	:	887 OLD COUNTRY RD
Second Line	:	SUITE K-L
City	:	RIVERHEAD
State	:	NY
Zip	:	11901-2115
Country	:	US
Telephone Number	:	631-727-2858
Fax Number	:	631-727-2866

Provider Business Practice Location Address
First Line	:	887 OLD COUNTRY RD
Second Line	:	SUITE K-L
City	:	RIVERHEAD
State	:	NY
Zip	:	11901-2115
Country	:	US
Telephone Number	:	631-727-2858
Fax Number	:	631-727-2866

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/23/2005
Last Update Date	:	01/08/2013

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