Provider Demographics
NPI:1285627661
Name:WILLIAMS, RAY D (OD)
Entity Type:Individual
Prefix:
First Name:RAY
Middle Name:D
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 1:1119 E LAMAR ST
Mailing Address - Street 2:P O BOX 788
Mailing Address - City:AMERICUS
Mailing Address - State:GA
Mailing Address - Zip Code:31709-3762
Mailing Address - Country:US
Mailing Address - Phone:229-924-4022
Mailing Address - Fax:229-924-7133
Practice Address - Street 1:1119 E LAMAR ST
Practice Address - Street 2:
Practice Address - City:AMERICUS
Practice Address - State:GA
Practice Address - Zip Code:31709-3762
Practice Address - Country:US
Practice Address - Phone:229-924-4022
Practice Address - Fax:229-924-7133
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000673152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000061597DMedicaid
GA00061597AMedicaid
GA55002054SAMedicare PIN
GA0404680001Medicare NSC
GA540003633Medicare PIN
GA00061597AMedicaid