Provider Demographics
NPI:1336117126
Name:WILLIAMS, JOE D (OD)
Entity Type:Individual
Prefix:
First Name:JOE
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 1:3408 OLSEN BLVD
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79109
Mailing Address - Country:US
Mailing Address - Phone:806-355-5633
Mailing Address - Fax:806-355-9133
Practice Address - Street 1:3408 OLSEN BLVD
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109
Practice Address - Country:US
Practice Address - Phone:806-355-5633
Practice Address - Fax:806-355-9133
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX03582T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX83136QOtherBCBS
TX046681501Medicaid
TX046681501Medicaid
TXT90589Medicare UPIN