Provider Demographics
NPI:1265502272
Name:JEFFREY W. WILLIAMS, O.D. & ASSOCIATES, PA
Entity Type:Organization
Organization Name:JEFFREY W. WILLIAMS, O.D. & ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:W
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:763-712-9854
Mailing Address - Street 1:3480 BUNKER LAKE BLVD NW
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MN
Mailing Address - Zip Code:55304-2085
Mailing Address - Country:US
Mailing Address - Phone:763-712-9854
Mailing Address - Fax:763-506-9962
Practice Address - Street 1:302 S KNOWLES AVE
Practice Address - Street 2:
Practice Address - City:NEW RICHMOND
Practice Address - State:WI
Practice Address - Zip Code:54017-1731
Practice Address - Country:US
Practice Address - Phone:715-246-2419
Practice Address - Fax:715-246-9434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1038332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier