Provider Demographics
NPI:1427043652
Name:WILLIAMS, ELWOOD (OPTICIAN)
Entity Type:Individual
Prefix:MR
First Name:ELWOOD
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:MR
Other - First Name:WOODY
Other - Middle Name:
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OPTICIAN
Mailing Address - Street 1:3600 TOWNE BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:FRANKLIN
Mailing Address - State:OH
Mailing Address - Zip Code:45005-5543
Mailing Address - Country:US
Mailing Address - Phone:513-424-5217
Mailing Address - Fax:513-424-0205
Practice Address - Street 1:3600 TOWNE BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:FRANKLIN
Practice Address - State:OH
Practice Address - Zip Code:45005-5543
Practice Address - Country:US
Practice Address - Phone:513-424-5217
Practice Address - Fax:513-424-0205
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-14
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2467SC156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0259107Medicaid
OH1318210001Medicare NSC