Provider Demographics
NPI:1396945143
Name:WILLIAMS, JEFFREY SLANEY JR (OD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:SLANEY
Last Name:WILLIAMS
Suffix:JR
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 1:887 OLD COUNTRY RD
Mailing Address - Street 2:SUITE G-K-L
Mailing Address - City:RIVERHEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11901-2115
Mailing Address - Country:US
Mailing Address - Phone:631-727-2858
Mailing Address - Fax:631-727-2866
Practice Address - Street 1:887 OLD COUNTRY RD
Practice Address - Street 2:SUITE G-K-L
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-2115
Practice Address - Country:US
Practice Address - Phone:631-727-2858
Practice Address - Fax:631-727-2866
Is Sole Proprietor?:No
Enumeration Date:2007-07-19
Last Update Date:2015-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7157152W00000X
OH5755152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02924216Medicaid
NY397137POtherHIP
NYC89741Medicare PIN
NY6129800001Medicare NSC