Provider Demographics
NPI:1093445090
Name:WILLIAM, AMY J
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:J
Last Name:WILLIAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:177 WASHINGTON DR
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42501-2938
Mailing Address - Country:US
Mailing Address - Phone:606-451-0044
Mailing Address - Fax:606-451-0339
Practice Address - Street 1:177 WASHINGTON DR
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42501-2938
Practice Address - Country:US
Practice Address - Phone:606-451-0044
Practice Address - Fax:606-451-0339
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-13
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY111827156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician