Individual provider Active NPI

Debra Lynne Williams, O.D.

  • Low Vision Rehabilitation Optometrist
  • Springfield, MO
National Provider Identifier
1215931886
Registry record updated Feb 6, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Low Vision Rehabilitation OptometristTaxonomy code 152WL0500X
License
T03116 Issued in MO
Practice address
4145 S McCann CT Ste D
Springfield, MO 65804-7232
Phone
(417) 598-0168
Fax
(417) 719-7955
NPI assigned
Jun 10, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 6, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X MOT03116 MO
Low Vision Rehabilitation Optometrist 152WL0500X T03116 MO Primary

Addresses

Primary practice location

4145 S McCann CT Ste D
Springfield, MO 65804-7232

Mailing address

4145 S McCann CT Ste D
Springfield, MO 65804-7232
Phone (417) 598-0168

Other identifiers 1

IdentifierTypeStateIssuer
317857019MedicaidMO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041020000830 MO Practitioner - Optometry 1850352154

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Pacific Medical College, 1993
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

1 Woodland Ave
Kimberling City, MO 65686-9738

Merit-based Incentive Payment System (MIPS)

Final score
0 of 100Reported as individual
Quality
0
Improvement activities
0
Cost
0

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery15

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

State licenses

LicenseStateTypeSpecialty
MOT03116MOMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Low Vision Specialists Low Vision Rehabilitation Current Accepting new patients
Tri Lakes Medical and Surgical Eye Clinic, Inc. Optometrist PastSince Mar 28, 2005 Accepting new patients

Locations

4145 S McCann Ct
Ste D
Springfield, MO 65804
Phone (417) 598-0168

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1118361600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1770336000000",
    "number": "1215931886",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4145 S MCCANN CT STE D",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658047232",
            "telephone_number": "417-598-0168",
            "fax_number": "417-719-7955"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4145 S MCCANN CT STE D",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658047232",
            "telephone_number": "417-598-0168",
            "fax_number": "417-719-7955"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIAMS",
        "first_name": "DEBRA",
        "middle_name": "LYNNE",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-06-10",
        "last_updated": "2026-02-06",
        "certification_date": "2026-02-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MO",
            "license": "MOT03116",
            "primary": false
        },
        {
            "code": "152WL0500X",
            "taxonomy_group": "",
            "desc": "Optometrist, Low Vision Rehabilitation",
            "state": "MO",
            "license": "T03116",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "317857019",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, MO

Sources for this page

Verify at the official NPI Registry.