Provider Demographics
NPI:1992270862
Name:MICHAEL A. WILLIAMS, OD, SC
Entity type:Organization
Organization Name:MICHAEL A. WILLIAMS, OD, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:618-407-4260
Mailing Address - Street 1:1040 COLLINSVILLE CROSSING BLVD
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62234-1882
Mailing Address - Country:US
Mailing Address - Phone:618-343-1508
Mailing Address - Fax:618-343-2083
Practice Address - Street 1:1040 COLLINSVILLE CROSSING BLVD
Practice Address - Street 2:
Practice Address - City:COLLINSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62234-1882
Practice Address - Country:US
Practice Address - Phone:618-343-1508
Practice Address - Fax:618-343-2083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-08
Last Update Date:2018-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty