Provider Demographics
NPI:1811979289
Name:WILLIAMS, AMY J (OD)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:J
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:333 N SUMMIT ST FL 7
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-1531
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1252 RALSTON AVE STE 400
Practice Address - Street 2:
Practice Address - City:DEFIANCE
Practice Address - State:OH
Practice Address - Zip Code:43512-1480
Practice Address - Country:US
Practice Address - Phone:419-782-6588
Practice Address - Fax:419-784-3622
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4600T1343152W00000X
OHOPT.004600152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2577082Medicaid
OH2577082Medicaid
OHU58670Medicare UPIN
OHWI0793116Medicare ID - Type Unspecified