Provider Demographics
NPI:1962472647
Name:WILLIAMS, JAMES D (OD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:D
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:PO BOX 607
Mailing Address - Street 2:
Mailing Address - City:PILOT MOUNTAIN
Mailing Address - State:NC
Mailing Address - Zip Code:27041-0607
Mailing Address - Country:US
Mailing Address - Phone:336-368-4727
Mailing Address - Fax:
Practice Address - Street 1:3732 CREEKSHIRE CT
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-1363
Practice Address - Country:US
Practice Address - Phone:336-793-5904
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1810152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC33982OtherMEDCOST
NC410044135OtherRAILROAD MEDICARE
NC2256632OtherUNITED HEALTHCARE
NC09290OtherBCBS
NC8909290Medicaid
NC33982OtherMEDCOST
NC2256632OtherUNITED HEALTHCARE