Provider Demographics
NPI:1225010804
Name:WILLIAMS, JAMES CARLYLE (OD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:CARLYLE
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 1:5120 SHAWGUEE RD
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:KS
Mailing Address - Zip Code:66536-9806
Mailing Address - Country:US
Mailing Address - Phone:785-437-6281
Mailing Address - Fax:
Practice Address - Street 1:809 N 3RD ST STE 200
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-6702
Practice Address - Country:US
Practice Address - Phone:785-537-2020
Practice Address - Fax:844-537-2020
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-18
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1360152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS053978OtherBCBS
KS100346610AMedicaid
KS053978Medicare PIN
KS053978OtherBCBS