Provider Demographics
NPI:1750334074
Name:WILLIAMS, JEFFREY W (OD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:W
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 1:200 VILLAGE CENTER DR STE 300
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55127-7088
Mailing Address - Country:US
Mailing Address - Phone:651-482-1959
Mailing Address - Fax:651-482-1850
Practice Address - Street 1:200 VILLAGE CENTER DR STE 300
Practice Address - Street 2:
Practice Address - City:NORTH OAKS
Practice Address - State:MN
Practice Address - Zip Code:55127-7088
Practice Address - Country:US
Practice Address - Phone:651-482-1959
Practice Address - Fax:651-482-1850
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3461152W00000X
MN2506152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNU51211Medicare UPIN