Provider Demographics
NPI:1720179351
Name:DR.RALPH E. WILLIAMS, DR. LEAH MCCONNAUGHEY & DR. KHRISTOPHER BALLARD,
Entity Type:Organization
Organization Name:DR.RALPH E. WILLIAMS, DR. LEAH MCCONNAUGHEY & DR. KHRISTOPHER BALLARD,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEAH
Authorized Official - Middle Name:L
Authorized Official - Last Name:MCCONNAUGHEY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:937-393-3212
Mailing Address - Street 1:PO BOX 670
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45133-0670
Mailing Address - Country:US
Mailing Address - Phone:937-393-3212
Mailing Address - Fax:937-393-5065
Practice Address - Street 1:934 WEST MAIN STREET
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OH
Practice Address - Zip Code:45133-7447
Practice Address - Country:US
Practice Address - Phone:937-393-3212
Practice Address - Fax:937-393-5065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2806152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3067909OtherAETNA
OH3067909OtherAETNA
OH4710400002Medicare NSC