Provider Demographics
NPI:1194173294
Name:WILLIAMS, MICAH (OD)
Entity type:Individual
Prefix:DR
First Name:MICAH
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2209 N 5TH ST
Mailing Address - Street 2:
Mailing Address - City:ELKO
Mailing Address - State:NV
Mailing Address - Zip Code:89801-2458
Mailing Address - Country:US
Mailing Address - Phone:775-738-8491
Mailing Address - Fax:775-738-3313
Practice Address - Street 1:2209 N 5TH ST
Practice Address - Street 2:
Practice Address - City:ELKO
Practice Address - State:NV
Practice Address - Zip Code:89801-2458
Practice Address - Country:US
Practice Address - Phone:775-738-8491
Practice Address - Fax:775-738-3313
Is Sole Proprietor?:No
Enumeration Date:2016-05-30
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9803296-9934152W00000X
NV1009152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist