1265502272 NPI number — JEFFREY W. WILLIAMS, O.D. & ASSOCIATES, PA

Table of content: (NPI 1265502272)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265502272 NPI number — JEFFREY W. WILLIAMS, O.D. & ASSOCIATES, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JEFFREY W. WILLIAMS, O.D. & ASSOCIATES, PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265502272
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3480 BUNKER LAKE BLVD NW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANDOVER
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55304-2085
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
763-712-9854
Provider Business Mailing Address Fax Number:
763-506-9962

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
302 S KNOWLES AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW RICHMOND
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54017-1731
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-246-2419
Provider Business Practice Location Address Fax Number:
715-246-9434
Provider Enumeration Date:
11/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WILLIAMS
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
W.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
763-712-9854

Provider Taxonomy Codes

  • Taxonomy code: 332H00000X , with the licence number:  1038 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com