Provider Demographics
NPI:1932414810
Name:WILLIAMS, KARA MARIE (OD)
Entity Type:Individual
Prefix:DR
First Name:KARA
Middle Name:MARIE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:KARA
Other - Middle Name:MARIE
Other - Last Name:PULSFUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:2401 W US HIGHWAY 20
Mailing Address - Street 2:SUITE 107
Mailing Address - City:PINGREE GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60140-8818
Mailing Address - Country:US
Mailing Address - Phone:224-569-1001
Mailing Address - Fax:847-423-6090
Practice Address - Street 1:2401 W US HIGHWAY 20
Practice Address - Street 2:SUITE 107
Practice Address - City:PINGREE GROVE
Practice Address - State:IL
Practice Address - Zip Code:60140-8818
Practice Address - Country:US
Practice Address - Phone:224-569-1001
Practice Address - Fax:847-423-6090
Is Sole Proprietor?:No
Enumeration Date:2010-08-16
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046010411152W00000X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL2751002OtherMEDICARE PTAN