Basic Information
| Provider Information | |||||||||
| NPI: | 1184604191 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WILLIAMS | ||||||||
| FirstName: | RENEE | ||||||||
| MiddleName: | ELIZABETH | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 400 S LOOP 336 W | ||||||||
| Address2: | |||||||||
| City: | CONROE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 773043302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9365394500 | ||||||||
| FaxNumber: | 9365394050 | ||||||||
| Practice Location | |||||||||
| Address1: | 4875 ALTAMA AVE | ||||||||
| Address2: | |||||||||
| City: | BRUNSWICK | ||||||||
| State: | GA | ||||||||
| PostalCode: | 315202912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9125540010 | ||||||||
| FaxNumber: | 9125540075 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2006 | ||||||||
| LastUpdateDate: | 07/26/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/26/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 8123-T | TX | N | Eye and Vision Services Providers | Optometrist | 152W00000X | OPT002279 | GA | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 786573174B | 05 | GA | MEDICAID | 786573174A | 05 | GA | MEDICAID | P00294702 | 01 | GA | RR MEDICARE | OTHER |