Provider Demographics
NPI:1881638005
Name:WILLIAMS, JEFFREY ALAN (OD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:ALAN
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 FORESTER AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532-3307
Mailing Address - Country:US
Mailing Address - Phone:251-538-7015
Mailing Address - Fax:251-945-1591
Practice Address - Street 1:18465 HIGHWAY 104
Practice Address - Street 2:
Practice Address - City:ROBERTSDALE
Practice Address - State:AL
Practice Address - Zip Code:36567-8725
Practice Address - Country:US
Practice Address - Phone:251-945-1609
Practice Address - Fax:251-945-1591
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS-751-TA-324152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALWI009910734Medicaid
ALWI009910734Medicaid
ALU27314Medicare UPIN
ALP00396430Medicare PIN