Provider Demographics
NPI:1922334879
Name:DR. GARY L. WILLIAMS OPTOMETRIST
Entity Type:Organization
Organization Name:DR. GARY L. WILLIAMS OPTOMETRIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TERI
Authorized Official - Middle Name:
Authorized Official - Last Name:AUNKST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-851-2414
Mailing Address - Street 1:1124 KEMPER MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45240-4117
Mailing Address - Country:US
Mailing Address - Phone:513-851-2414
Mailing Address - Fax:513-851-6159
Practice Address - Street 1:1124 KEMPER MEADOW DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45240-4117
Practice Address - Country:US
Practice Address - Phone:513-851-2414
Practice Address - Fax:513-851-6159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-28
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0279600001Medicare NSC
OH0418571Medicare PIN