Provider Demographics
NPI:1346296043
Name:WILLIAMS, GARY LESTER (OD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:LESTER
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 1:1124 KEMPER MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45240-4117
Mailing Address - Country:US
Mailing Address - Phone:513-851-2414
Mailing Address - Fax:513-851-6159
Practice Address - Street 1:1124 KEMPER MEADOW DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45240-4117
Practice Address - Country:US
Practice Address - Phone:513-851-2414
Practice Address - Fax:513-851-6159
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2008-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH3097152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0418571Medicare PIN
OH0279600001Medicare NSC