Provider Demographics
NPI:1679653208
Name:WILLIAMS, JULIE KRISTINA (OD)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:KRISTINA
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:KRISTINA
Other - Last Name:TRAMP
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 117
Mailing Address - Street 2:
Mailing Address - City:WAGNER
Mailing Address - State:SD
Mailing Address - Zip Code:57380-0117
Mailing Address - Country:US
Mailing Address - Phone:605-384-3555
Mailing Address - Fax:
Practice Address - Street 1:111 WASHINGTON AVE
Practice Address - Street 2:WAGNER INDIAN HEALTH SERVICES
Practice Address - City:WAGNER
Practice Address - State:SD
Practice Address - Zip Code:57380
Practice Address - Country:US
Practice Address - Phone:605-384-3621
Practice Address - Fax:605-384-5975
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02309152W00000X
MN3000152W00000X
SD607152W00000X
NE1233152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDMW1216161OtherDEA REG NUMBER