Provider Demographics
NPI:1104933258
Name:WILLIAMS-MCDERMED, JENNIFER (OD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:WILLIAMS-MCDERMED
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:JENNA
Other - Middle Name:
Other - Last Name:MCDERMED
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:12301 LAKE UNDERHILL RD
Mailing Address - Street 2:SUITE 236
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-4508
Mailing Address - Country:US
Mailing Address - Phone:407-277-5729
Mailing Address - Fax:
Practice Address - Street 1:12301 LAKE UNDERHILL RD
Practice Address - Street 2:SUITE 236
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-4508
Practice Address - Country:US
Practice Address - Phone:407-277-5729
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 4185152WP0200X, 152WS0006X, 152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision