Provider Demographics
NPI:1720179997
Name:WILLIAMS, CHANDRA M (OD)
Entity Type:Individual
Prefix:
First Name:CHANDRA
Middle Name:M
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13453 N MAIN ST STE 203
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218-2773
Mailing Address - Country:US
Mailing Address - Phone:904-696-2027
Mailing Address - Fax:904-696-2028
Practice Address - Street 1:13453 N MAIN ST STE 203
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-2773
Practice Address - Country:US
Practice Address - Phone:904-696-2027
Practice Address - Fax:904-696-2028
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2024-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOEG001840152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00462502OtherMEDICARE RAILROAD
FL36102OtherBCBS INDIVIDUAL ID
FL36102OtherBCBS INDIVIDUAL ID