Walter Keandre Desean Williams IV, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

18004506A Issued in IN

Practice address

519 State St
New Albany, IN 47150-3620

Phone

(812) 948-0616

NPI assigned

Mar 22, 2024

Last updated

Jun 11, 2026By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Walt Williams IV Other 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, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Eye Centers of Louisville,PSCGroup PAC ID 4789584921, 31 clinicians

John Kenyon American Eye Institute, LLCGroup PAC ID 5496640351, 8 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
• Direct secure messaging: walter.keandredeseanwilliamiv.p1@direct.johnkenyon.nextgenshare.com
• Direct secure messaging: wwilliams@bennettbloomeyecenters.imwdirect.com

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.

• John Kenyon American Eye Institute LLC

  • Ophthalmology Physician
  • New Albany, IN
  • NPI 1447259510

  KY, Optometrist

  Medicare reassignment Care Compare group NPD
• Eye Centers of Louisville,PSC

  dba Bennett & Bloom Eye Centers

  • Ophthalmology Physician
  • Louisville, KY
  • NPI 1659385508

  IN, Optometrist

  Medicare reassignment Care Compare group NPD
• First Impressions Optometric Associates, LLC

  • Optometrist
  • Bloomington, IN
  • NPI 1083366363
  Medicare reassignment NPD
• First Impressions Optometric Associates, LLC

  • Eyewear Supplier
  • Highland, IN
  • NPI 1942960539

  Optometrist

  NPD
• Eye Centers of Louisville,P.S.C.

  dba Bluegrass Surgery & Laser Center

  • Ambulatory Surgical Clinic/Center
  • Louisville, KY
  • NPI 1396763074
  NPD
• John Kenyon American Eye Institute LLC

  dba Eye Surgery Center of Elizabethtown

  • Ambulatory Surgical Clinic/Center
  • Elizabethtown, KY
  • NPI 1013513308
  NPD

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

{
    "created_epoch": "1711065600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1781136000000",
    "number": "1720838873",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "519 STATE ST",
            "city": "NEW ALBANY",
            "state": "IN",
            "postal_code": "471503620",
            "telephone_number": "812-948-0616"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "519 STATE ST",
            "city": "NEW ALBANY",
            "state": "IN",
            "postal_code": "471503620",
            "telephone_number": "812-948-0616"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "73 Quartermaster Ct",
            "address_purpose": "LOCATION",
            "city": "Jeffersonville",
            "state": "IN",
            "postal_code": "471303623",
            "country_code": "US",
            "telephone_number": "812-284-0077",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1305 Wall St",
            "address_purpose": "LOCATION",
            "city": "Jeffersonville",
            "state": "IN",
            "postal_code": "471303853",
            "country_code": "US",
            "telephone_number": "812-288-9011",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "9200 Leesgate Rd",
            "address_purpose": "LOCATION",
            "city": "Louisville",
            "state": "KY",
            "postal_code": "402225173",
            "country_code": "US",
            "telephone_number": "502-895-2910",
            "fax_number": "502-894-8668",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2200 E Parrish Ave Ste 201",
            "address_purpose": "LOCATION",
            "city": "Owensboro",
            "state": "KY",
            "postal_code": "423031449",
            "country_code": "US",
            "telephone_number": "812-948-0616",
            "fax_number": "812-949-3446",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILLIAMS",
        "first_name": "WALTER",
        "middle_name": "KEANDRE DESEAN",
        "name_prefix": "Dr.",
        "name_suffix": "IV",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-03-22",
        "last_updated": "2026-06-11",
        "certification_date": "2026-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IN",
            "license": "18004506A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100983530",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300092192",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "WALT",
            "last_name": "WILLIAMS",
            "suffix": "IV",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Brittany Williams, RBT
• James Michael Williams, DMD
• Julia Ellen Danzl Williams, NP
• Kristina D Williams, NP
• Nicholas Williams, RBT
• Wendy I Willis, LCSW
• Kayla Elizabeth Willoughby, MSW, LSW
• Cameron Lebron Wilson
• Creagh Page Wilson, M.ED.
• Jamie Lynn Wilson, APRN

• Optometrist in New Albany, IN
• Providers in New Albany, IN by specialty
• Optometrist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 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.