Provider Demographics
NPI:1215931886
Name:WILLIAMS, DEBRA LYNNE (OD)
Entity type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:LYNNE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 WOODLAND AVE
Mailing Address - Street 2:STE 2
Mailing Address - City:KIMBERLING CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65686-9738
Mailing Address - Country:US
Mailing Address - Phone:417-739-2411
Mailing Address - Fax:417-739-2407
Practice Address - Street 1:1 WOODLAND AVE
Practice Address - Street 2:STE 2
Practice Address - City:KIMBERLING CITY
Practice Address - State:MO
Practice Address - Zip Code:65686-9738
Practice Address - Country:US
Practice Address - Phone:417-739-2411
Practice Address - Fax:417-739-2407
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMOT03116152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO317857019Medicaid
MO912364384Medicare ID - Type Unspecified
MOU50298Medicare UPIN