Provider Demographics
NPI:1437260569
Name:WILLIAMS, MELODY DAWN (OD)
Entity Type:Individual
Prefix:DR
First Name:MELODY
Middle Name:DAWN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1029 S POST RD
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73130-5601
Mailing Address - Country:US
Mailing Address - Phone:405-737-0713
Mailing Address - Fax:405-732-2225
Practice Address - Street 1:1029 S POST RD
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73130-5601
Practice Address - Country:US
Practice Address - Phone:405-737-0713
Practice Address - Fax:405-732-2225
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2461152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKOK700016Medicare PIN