Jacqueline Anne Williams, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

18004589A Issued in IN

Practice address

1407 Spring St Ste 1
Jeffersonvlle, IN 47130-3748

Phone

(812) 590-6220

NPI assigned

Jun 23, 2025

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Jacqueline A Petersen Former name

Medicare fee-for-service enrollment

Enrolled in IN, KY2 enrollments

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 2

Specialty

Optometry

Education

Indiana University - School of Optometry, 2025

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Eye Associates of Southern Indiana PCGroup PAC ID 4183688310, 25 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jacqueline.petersenod.p1@direct.have2020.nextgenshare.com

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.

• Eye Associates of Southern Indiana PC

  • Ophthalmology Physician
  • Jeffersonville, IN
  • NPI 1336219922

  KY, Optometrist

  Medicare reassignment Care Compare group NPD
• Eye Associates of Southern Indiana PC

  • Optometrist
  • Frankfort, KY
  • NPI 1962533851
  NPD
• Eye Associates of Southern Indiana PC

  • Durable Medical Equipment & Medical Supplies
  • New Albany, IN
  • NPI 1083607592

  Optometrist

  NPD (past)

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

{
    "created_epoch": "1750636800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1768262400000",
    "number": "1629965496",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "302 W 14TH ST STE 100A",
            "city": "JEFFERSONVLLE",
            "state": "IN",
            "postal_code": "471303751",
            "telephone_number": "812-284-0660"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1407 SPRING ST STE 1",
            "city": "JEFFERSONVLLE",
            "state": "IN",
            "postal_code": "471303748",
            "telephone_number": "812-590-6220"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1102 Lyndon Ln Ste A",
            "address_purpose": "LOCATION",
            "city": "Louisville",
            "state": "KY",
            "postal_code": "402224320",
            "country_code": "US",
            "telephone_number": "502-426-0307",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "302 W 14th St Ste 100A",
            "address_purpose": "LOCATION",
            "city": "Jeffersonvlle",
            "state": "IN",
            "postal_code": "471303751",
            "country_code": "US",
            "telephone_number": "812-284-0660",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILLIAMS",
        "first_name": "JACQUELINE",
        "middle_name": "ANNE",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-06-23",
        "last_updated": "2026-01-13",
        "certification_date": "2026-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IN",
            "license": "18004589A",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "KY",
            "license": "2448DT",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACQUELINE",
            "last_name": "PETERSEN",
            "middle_name": "A",
            "credential": "OD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Larry P Mudd, LCSW
• Noell L Rowan, LCSW
• Sydney Elizabeth Sims, PA-C
• Samantha Blain Sisco, NP
• Christopher Ryan Von Kaenel, PA-C
• Wyoming Medicine and Pharmacy LLC
• Melissa Jean Yannetti, DO

• Optometrist in Jeffersonvlle, IN
• Providers in Jeffersonvlle, IN by specialty
• Optometrist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2026; 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.