Provider Demographics
NPI:1073926366
Name:WW EYECAR & SURGERY LLC
Entity Type:Organization
Organization Name:WW EYECAR & SURGERY LLC
Other - Org Name:NANCY E. WILLIAMS-WALLACE MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:E
Authorized Official - Last Name:WILLIAMS-WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-772-7712
Mailing Address - Street 1:32615 US HIGHWAY 19 N STE 6
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684-3176
Mailing Address - Country:US
Mailing Address - Phone:727-772-7712
Mailing Address - Fax:727-772-6891
Practice Address - Street 1:32615 US HIGHWAY 19 N STE 6
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-3176
Practice Address - Country:US
Practice Address - Phone:727-772-7712
Practice Address - Fax:727-772-6891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-04
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME69004174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL378657900Medicaid
FL378657900Medicaid