Provider Demographics
NPI:1548424302
Name:JEFFREY S. WILLIAMS, JR
Entity Type:Organization
Organization Name:JEFFREY S. WILLIAMS, JR
Other - Org Name:JEFFREY S. WILLIAMS, JR. OD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:SLANEY
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:JR
Authorized Official - Credentials:OD
Authorized Official - Phone:631-727-2858
Mailing Address - Street 1:307 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RIVERHEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11901-2404
Mailing Address - Country:US
Mailing Address - Phone:631-727-2858
Mailing Address - Fax:631-727-2866
Practice Address - Street 1:307 E MAIN ST
Practice Address - Street 2:
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-2404
Practice Address - Country:US
Practice Address - Phone:631-727-2858
Practice Address - Fax:631-727-2866
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JEFFREY S. WILLIAMS, OD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-07-10
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV007157332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier