Provider Demographics
NPI:1760404420
Name:WILLIAMS, ASHLEY R (OD)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:R
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 1:406 DALLAS AVE
Mailing Address - Street 2:
Mailing Address - City:SELMA
Mailing Address - State:AL
Mailing Address - Zip Code:36701-5746
Mailing Address - Country:US
Mailing Address - Phone:334-878-2020
Mailing Address - Fax:334-878-2025
Practice Address - Street 1:406 DALLAS AVE
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:AL
Practice Address - Zip Code:36701-5746
Practice Address - Country:US
Practice Address - Phone:334-878-2020
Practice Address - Fax:334-878-2025
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALSA24TA601152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051512107OtherBCBS
AL009901935Medicaid
AL051552649Medicare PIN
AL051512107OtherBCBS