Provider Demographics
NPI:1396817540
Name:GARY J. WILLIAMS OD FAMILY EYE CARE PC
Entity Type:Organization
Organization Name:GARY J. WILLIAMS OD FAMILY EYE CARE PC
Other - Org Name:GARY J. WILLIAMS & RAYMOND J. MINT OD PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:J
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:607-687-3391
Mailing Address - Street 1:293 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:OWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13827-1615
Mailing Address - Country:US
Mailing Address - Phone:607-687-3391
Mailing Address - Fax:607-687-4226
Practice Address - Street 1:293 MAIN STREET
Practice Address - Street 2:
Practice Address - City:OWEGO
Practice Address - State:NY
Practice Address - Zip Code:13827-1615
Practice Address - Country:US
Practice Address - Phone:607-687-3391
Practice Address - Fax:607-687-4226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV003216-1152W00000X
NYTUV007227-1152W00000X
NY3216152W00000X, 152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
34782AMedicare PIN
NY34782CMedicare ID - Type UnspecifiedGROUP NUMBER
NY0166590001Medicare NSC
U02412Medicare UPIN