Provider Demographics
NPI:1275614265
Name:WILLIAMS, KERRY L (OD)
Entity Type:Individual
Prefix:DR
First Name:KERRY
Middle Name:L
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:KERRY
Other - Middle Name:E
Other - Last Name:LONGO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:231 CROSSWICKS RD STE 1
Mailing Address - Street 2:
Mailing Address - City:BORDENTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08505-2602
Mailing Address - Country:US
Mailing Address - Phone:609-379-6014
Mailing Address - Fax:609-379-6037
Practice Address - Street 1:231 CROSSWICKS RD STE 1
Practice Address - Street 2:
Practice Address - City:BORDENTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08505-2602
Practice Address - Country:US
Practice Address - Phone:609-379-6014
Practice Address - Fax:609-379-6037
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00575402152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist