Provider Demographics
NPI:1386698132
Name:WILLIAMS, MICHAEL FREDERICK (OD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:FREDERICK
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 1:2155 ALLENTOWN RD
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45805-1705
Mailing Address - Country:US
Mailing Address - Phone:419-338-3800
Mailing Address - Fax:419-222-1596
Practice Address - Street 1:2155 ALLENTOWN RD
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45805-1705
Practice Address - Country:US
Practice Address - Phone:419-338-3800
Practice Address - Fax:419-222-1596
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5422 T2333152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2632539Medicaid
OH2632539Medicaid
U96271Medicare UPIN