Provider Demographics
NPI:1013047679
Name:WILLIAMS, LISA GAY (OD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:GAY
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 1:986 GREERLAND DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37204-4035
Mailing Address - Country:US
Mailing Address - Phone:615-385-4018
Mailing Address - Fax:
Practice Address - Street 1:4424 LEBANON PIKE
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076-1312
Practice Address - Country:US
Practice Address - Phone:615-884-7999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1330152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U32997Medicare UPIN
TN3946003Medicare ID - Type Unspecified