MEDICARE: DR GRADY JOSEPH WILLIAMS LLC

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	261Q00000X	Clinic/Center	296	NV

General Provider Information

NPI Number	:	1467644831
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR GRADY JOSEPH WILLIAMS LLC

Provider Business Mailing Address
First Line	:	840 S RANCHO DR
Second Line	:	SUITE 1
City	:	LAS VEGAS
State	:	NV
Zip	:	89106-3837
Country	:	US
Telephone Number	:	702-870-5911
Fax Number	:	702-870-2368

Provider Business Practice Location Address
First Line	:	840 S RANCHO DR
Second Line	:	SUITE 1
City	:	LAS VEGAS
State	:	NV
Zip	:	89106-3837
Country	:	US
Telephone Number	:	702-870-5911
Fax Number	:	702-870-2368

Authorized Official
Title or Position	:	OWNER
Name	:	DR. GRADY JOSEPH WILLIAMS LLC
Credential	:	OPTOMETRIST
Telephone Number	:	702-809-8899

Provider Enumeration Date	:	08/09/2007
Last Update Date	:	10/21/2016

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