Mark P Williams, O.D.

Primary specialty

Low Vision Rehabilitation OptometristTaxonomy code 152WL0500X

License

4901002607 Issued in MI

Practice address

4067 E Court St
#10-11
Burton, MI 48509-2509

Phone

(810) 715-2020

Fax

(810) 715-2021

NPI assigned

Jan 6, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in MI

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

Southern California College of Optometry, 1977

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Clio Vision Services IncGroup PAC ID 5092607804, 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.

• Clio Vision Services Inc

  • Optometrist
  • Clio, MI
  • NPI 1952432361
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1168041600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625702400000",
    "number": "1518015759",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4067 E COURT ST # 10-11",
            "city": "BURTON",
            "state": "MI",
            "postal_code": "485092509",
            "telephone_number": "810-715-2020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4067 E COURT ST",
            "address_2": "#10-11",
            "city": "BURTON",
            "state": "MI",
            "postal_code": "485092509",
            "telephone_number": "810-715-2020",
            "fax_number": "810-715-2021"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIAMS",
        "first_name": "MARK",
        "middle_name": "P",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-06",
        "last_updated": "2021-07-08",
        "certification_date": "2021-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152WL0500X",
            "taxonomy_group": "",
            "desc": "Optometrist, Low Vision Rehabilitation",
            "state": "MI",
            "license": "4901002607",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MI",
            "license": "4901002607",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MCLAREN PROVIDER NUMBER",
            "identifier": "202115",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER NUMBER",
            "identifier": "900B56586",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "945104868",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ALL OTHER INS",
            "identifier": "382219845",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• William H Moon Jr DDS
• Amariana Williams
• Breyana Williams
• Douglas Steven Williams III
• Keith M Williams, DDS
• Ross H Williams, OD
• Nia Jane Willis
• Rachelle Renay Willits
• Breanna Wilson
• Zachary Wisniewski, D.D.S

• Low Vision Rehabilitation Optometrist in Burton, MI
• Providers in Burton, MI by specialty
• Low Vision Rehabilitation Optometrist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2021; 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.