Provider Demographics
NPI:1679170641
Name:MCWILLIAMS, JOSEPH C
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:C
Last Name:MCWILLIAMS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 30032
Mailing Address - Street 2:
Mailing Address - City:CENTRAL
Mailing Address - State:AK
Mailing Address - Zip Code:99730-0032
Mailing Address - Country:US
Mailing Address - Phone:907-520-5496
Mailing Address - Fax:
Practice Address - Street 1:29 COLLEGE RD STE 14
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-1739
Practice Address - Country:US
Practice Address - Phone:907-590-1821
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-02
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK2110250332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK2110250OtherBUSINESS LICENSE