Basic Information
| Provider Information | |||||||||
| NPI: | 1285738617 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WILLEMS | ||||||||
| FirstName: | SHEILA | ||||||||
| MiddleName: | MICHELLE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 180 MICHAEL CIR | ||||||||
| Address2: | |||||||||
| City: | PRESCOTT | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 863015476 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9287764049 | ||||||||
| FaxNumber: | 9287723972 | ||||||||
| Practice Location | |||||||||
| Address1: | 500 HWY 89 NORTH | ||||||||
| Address2: | NORTHERN ARIZONA VA HEALTHCARE SYSTEM | ||||||||
| City: | PRESCOTT | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 86313 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9284454860 | ||||||||
| FaxNumber: | 9287177553 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/07/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 1001 | AZ | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.