Mark Alan Williams, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

18003424A Issued in IN

Practice address

307 Sagamore Pkwy W
West Lafayette, IN 47906-1500

Phone

(765) 463-4558

Fax

(765) 497-2154

NPI assigned

Oct 18, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IN

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

Specialty

Optometry

Education

Indiana University - School of Optometry, 2006

Medicare assignment

May accept Medicare assignment

Group practices

Jek Asset Management LLCGroup PAC ID 4880919786, 2 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Jek Asset Management, LLC

  • Optometrist
  • West Lafayette, IN
  • NPI 1326437195

  IN, Optometrist

  Medicare reassignment Care Compare group NPD
• Eyecare Indiana LL, PC

  • Optometrist
  • Mishawaka, IN
  • NPI 1134485360
  NPD (past)

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

{
    "created_epoch": "1161129600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1601251200000",
    "number": "1508947276",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "307 SAGAMORE PKWY W",
            "city": "WEST LAFAYETTE",
            "state": "IN",
            "postal_code": "479061500",
            "telephone_number": "765-463-4558",
            "fax_number": "765-497-2154"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "307 SAGAMORE PKWY W",
            "city": "WEST LAFAYETTE",
            "state": "IN",
            "postal_code": "479061500",
            "telephone_number": "765-463-4558",
            "fax_number": "765-497-2154"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIAMS",
        "first_name": "MARK",
        "middle_name": "ALAN",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-18",
        "last_updated": "2020-09-28",
        "certification_date": "2020-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IN",
            "license": "18003424A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIANA LICENSE",
            "identifier": "18003424A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Heather May Wilberg, B.S.
• Mitsue Alice Wilcoxson, ATC, PT
• Brittany Michelle Williams, PHARMD
• Kasey Williams, NP
• Kerry Lorton Williams, CNA/ CHHA
• Nicole Williams
• Tamika R Williams
• Toccara Nicole Wilson-King
• Kennedy Wilson
• Tatiana Wilson

• All providers in West Lafayette, IN
• Optometrist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.