Provider Demographics
NPI:1770513624
Name:WILLIAMS, JOSEPH HOOPER (OD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:HOOPER
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:J.
Other - Middle Name:HOOPER
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:188 MEDICAL PARK DR STE C
Mailing Address - Street 2:
Mailing Address - City:BREVARD
Mailing Address - State:NC
Mailing Address - Zip Code:28712-4188
Mailing Address - Country:US
Mailing Address - Phone:828-884-7320
Mailing Address - Fax:828-877-6191
Practice Address - Street 1:188 MEDICAL PARK DR STE C
Practice Address - Street 2:
Practice Address - City:BREVARD
Practice Address - State:NC
Practice Address - Zip Code:28712-4188
Practice Address - Country:US
Practice Address - Phone:828-884-7320
Practice Address - Fax:828-877-6191
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1275152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0840690003OtherDMEPOS
NC890996HMedicaid
0840690001OtherDMEPOS
NC0996HOtherBCBS
T65063Medicare UPIN
NC410041992Medicare PIN