Provider Demographics
NPI:1851602650
Name:FRANK E WILLIAMS IV OD PC
Entity Type:Organization
Organization Name:FRANK E WILLIAMS IV OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:E
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:IV
Authorized Official - Credentials:OD
Authorized Official - Phone:308-345-1573
Mailing Address - Street 1:503 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:MC COOK
Mailing Address - State:NE
Mailing Address - Zip Code:69001-2815
Mailing Address - Country:US
Mailing Address - Phone:308-345-5825
Mailing Address - Fax:308-345-2106
Practice Address - Street 1:1902 W B ST
Practice Address - Street 2:
Practice Address - City:MC COOK
Practice Address - State:NE
Practice Address - Zip Code:69001-3579
Practice Address - Country:US
Practice Address - Phone:308-345-1573
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-25
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025049300Medicaid
NE272900Medicare PIN
NE10025049300Medicaid