Provider Demographics
NPI:1912199597
Name:WILLIAMS, MICHAEL AUDY (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:AUDY
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:841 FOXGROVE DR
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:62208-2095
Mailing Address - Country:US
Mailing Address - Phone:618-407-4260
Mailing Address - Fax:618-343-2083
Practice Address - Street 1:1040 COLLINSVILLE CROSSING BLVD
Practice Address - Street 2:
Practice Address - City:COLLINSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62234-1882
Practice Address - Country:US
Practice Address - Phone:618-343-1508
Practice Address - Fax:618-343-2083
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-16
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL046-009276152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist