Provider Demographics
NPI:1144462862
Name:WOODY WILLIAMS VISION CENTER
Entity type:Organization
Organization Name:WOODY WILLIAMS VISION CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WOODY
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:LICENSED OPTICIAN
Authorized Official - Phone:513-424-5217
Mailing Address - Street 1:3600 TOWNE BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:FRANKLIN
Mailing Address - State:OH
Mailing Address - Zip Code:45005-5543
Mailing Address - Country:US
Mailing Address - Phone:513-424-5217
Mailing Address - Fax:513-424-0205
Practice Address - Street 1:3600 TOWNE BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:FRANKLIN
Practice Address - State:OH
Practice Address - Zip Code:45005-5543
Practice Address - Country:US
Practice Address - Phone:513-424-5217
Practice Address - Fax:513-424-0205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-26
Last Update Date:2009-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2467SC332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0259107Medicaid