Provider Demographics
NPI:1417943168
Name:WILLIAMS, DAWN D (OD)
Entity Type:Individual
Prefix:DR
First Name:DAWN
Middle Name:D
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:DAWN
Other - Middle Name:D
Other - Last Name:WORMINGTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:707 E KANSAS PLZ
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67846-5866
Mailing Address - Country:US
Mailing Address - Phone:620-276-3381
Mailing Address - Fax:620-275-7507
Practice Address - Street 1:707 E KANSAS PLZ
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:KS
Practice Address - Zip Code:67846-5866
Practice Address - Country:US
Practice Address - Phone:620-276-3381
Practice Address - Fax:620-275-7507
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2010-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOPT 2382152W00000X
KS1761152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200417960AMedicaid
650519OtherMEDICARE GROUP NUMBER
651147Medicare PIN
U97134Medicare UPIN
1039620001Medicare NSC