Individual provider Active NPI

Julie Kristina Williams, OD

  • Optometrist
  • Wagner, SD
National Provider Identifier
1679653208
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
607 Issued in SD
Practice address
111 Washington Ave
Wagner Indian Health Services
Wagner, SD 57380
Phone
(605) 384-3621
Fax
(605) 384-5975
NPI assigned
Oct 17, 2006
Last updated
Mar 7, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 02309 IA
Optometrist 152W00000X 3000 MN
Optometrist 152W00000X 607 SD Primary
Optometrist 152W00000X 1233 NE

Addresses

Primary practice location

111 Washington Ave
Wagner Indian Health Services
Wagner, SD 57380

Mailing address

PO Box 117
Wagner, SD 57380-0117
Phone (605) 384-3555

Other names 1

  • Julie Kristina Tramp Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20050309000122 TX Practitioner - Optometry 8426002809 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Indiana University - School of Optometry, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Wagner Indian Health Service Health CenterGroup PAC ID 6305758483, 15 clinicians

Practice addresses (Care Compare)

111 Washington Ave NW
Wagner, SD 57380-4300
Phone (605) 384-4820

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
607SDMDClinical Psychologist
3000MNMDPhysical Therapist
1233NEMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Wagner Indian Health Service Health Center CurrentSince Dec 13, 2004 Accepting new patients

Locations

111 Washington Ave NW
Wagner, SD 57380
Phone (605) 384-3621

Organizations & group practices 1

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

NPI Registry JSON

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

{
    "created_epoch": "1161043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1679653208",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 117",
            "city": "WAGNER",
            "state": "SD",
            "postal_code": "573800117",
            "telephone_number": "605-384-3555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 WASHINGTON AVE",
            "address_2": "WAGNER INDIAN HEALTH SERVICES",
            "city": "WAGNER",
            "state": "SD",
            "postal_code": "57380",
            "telephone_number": "605-384-3621",
            "fax_number": "605-384-5975"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIAMS",
        "first_name": "JULIE",
        "middle_name": "KRISTINA",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-17",
        "last_updated": "2023-03-07",
        "certification_date": "2022-03-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IA",
            "license": "02309",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MN",
            "license": "3000",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "SD",
            "license": "607",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NE",
            "license": "1233",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JULIE",
            "last_name": "TRAMP",
            "middle_name": "KRISTINA",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Wagner, SD

Sources for this page

Verify at the official NPI Registry.