Provider Demographics
NPI:1407852106
Name:WILLIAMS EYE INSTITUTE OPTICAL
Entity Type:Organization
Organization Name:WILLIAMS EYE INSTITUTE OPTICAL
Other - Org Name:WILLIAMS EYE INSTITUTE OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-931-7509
Mailing Address - Street 1:6850 HOHMAN AVE
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:IN
Mailing Address - Zip Code:46324-1410
Mailing Address - Country:US
Mailing Address - Phone:219-937-5090
Mailing Address - Fax:219-937-5093
Practice Address - Street 1:6850 HOHMAN AVE
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:IN
Practice Address - Zip Code:46324-1410
Practice Address - Country:US
Practice Address - Phone:219-937-5090
Practice Address - Fax:219-937-5093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-27
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN0186490001Medicare NSC