Provider Demographics
NPI:1851886865
Name:WILLIAMS, NICOLE AMANDA (OD)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:AMANDA
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 1:147 S 4TH ST APT 5
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18042-4489
Mailing Address - Country:US
Mailing Address - Phone:862-266-7497
Mailing Address - Fax:
Practice Address - Street 1:2020 SULLIVAN TRL
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18040-8354
Practice Address - Country:US
Practice Address - Phone:610-258-6666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-22
Last Update Date:2018-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG003408152WC0802X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management