Provider Demographics
NPI:1417000589
Name:WILLIAMS, BILL RHYS (OD)
Entity Type:Individual
Prefix:DR
First Name:BILL
Middle Name:RHYS
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 1:714 G ST
Mailing Address - Street 2:P.O. BOX 615
Mailing Address - City:RUPERT
Mailing Address - State:ID
Mailing Address - Zip Code:83350-1612
Mailing Address - Country:US
Mailing Address - Phone:208-436-3455
Mailing Address - Fax:208-436-3195
Practice Address - Street 1:714 G ST
Practice Address - Street 2:
Practice Address - City:RUPERT
Practice Address - State:ID
Practice Address - Zip Code:83350-1612
Practice Address - Country:US
Practice Address - Phone:208-436-3455
Practice Address - Fax:208-436-3195
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDODP 512152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID002459500Medicaid
ID1590887Medicare ID - Type Unspecified
ID002459500Medicaid