Provider Demographics
NPI:1508977752
Name:WILLIAMS, JOE L (OD)
Entity Type:Individual
Prefix:DR
First Name:JOE
Middle Name:L
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 1:700 PIER 3
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68528
Mailing Address - Country:US
Mailing Address - Phone:402-440-0899
Mailing Address - Fax:402-438-4393
Practice Address - Street 1:4700 N 27TH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68521-1190
Practice Address - Country:US
Practice Address - Phone:402-438-4386
Practice Address - Fax:402-438-4393
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2011-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE910152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025573300Medicaid
NET40304Medicare UPIN
NE10025573300Medicaid