Provider Demographics
NPI:1639142946
Name:WILLIAMS, GARY J (OD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:J
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 1:293 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:OWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13827-1615
Mailing Address - Country:US
Mailing Address - Phone:607-687-3391
Mailing Address - Fax:607-687-4226
Practice Address - Street 1:293 MAIN ST
Practice Address - Street 2:
Practice Address - City:OWEGO
Practice Address - State:NY
Practice Address - Zip Code:13827-1615
Practice Address - Country:US
Practice Address - Phone:607-687-3391
Practice Address - Fax:607-687-4226
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3216152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
4535964OtherAETNA
598015OtherMVP
U02413Medicare UPIN
34782BMedicare ID - Type Unspecified