Provider Demographics
NPI:1114538246
Name:WILLIAMS, KYLE ANDREW (OD)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:ANDREW
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:159 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-2526
Mailing Address - Country:US
Mailing Address - Phone:740-773-6347
Mailing Address - Fax:740-773-9093
Practice Address - Street 1:159 E 2ND ST
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-2526
Practice Address - Country:US
Practice Address - Phone:740-773-6347
Practice Address - Fax:740-773-9093
Is Sole Proprietor?:No
Enumeration Date:2020-08-12
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOPT.006922152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist