Provider Demographics
NPI:1467644831
Name:DR GRADY JOSEPH WILLIAMS LLC
Entity Type:Organization
Organization Name:DR GRADY JOSEPH WILLIAMS LLC
Other - Org Name:DR GRADY JOSEPH WILLIAMS LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GRADY
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:WILLIAMS LLC
Authorized Official - Suffix:
Authorized Official - Credentials:OPTOMETRIST
Authorized Official - Phone:702-809-8899
Mailing Address - Street 1:840 S RANCHO DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-3837
Mailing Address - Country:US
Mailing Address - Phone:702-870-5911
Mailing Address - Fax:702-870-2368
Practice Address - Street 1:840 S RANCHO DR
Practice Address - Street 2:SUITE 1
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-3837
Practice Address - Country:US
Practice Address - Phone:702-870-5911
Practice Address - Fax:702-870-2368
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DR GRADY JOSEPH WILLIAMS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-09
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV296261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVT19586Medicare UPIN