NPIMap

Individual provider Active NPI

Jill L Williamson, OD

  • Optometrist
  • Evansville, IN
National Provider Identifier
1881614022
Registry record updated May 13, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2005020671 Issued in MO
Practice address
1614 N Green River Rd
Evansville, IN 47715-1902
Phone
(812) 618-0423
Fax
(812) 618-2866
NPI assigned
Jul 20, 2006
Last updated
May 13, 2015By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 13, 2015

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 2005020671 MO Primary
Optometrist 152W00000X 046.009784 IL
Optometrist 152W00000X 18003661A IN

Addresses

Primary practice location

1614 N Green River Rd
Evansville, IN 47715-1902

Mailing address

1614 N Green River Rd
Evansville, IN 47715-1902
Phone (812) 618-0423

Other identifiers 1

IdentifierTypeStateIssuer
1881614022MedicaidMO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
046.009784ILMDOptometrist
18003661AINMDOptometrist
2005020671MOMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Rosen Optometry Associates Inc Optometrist Past Accepting new patients
Overland Optical, Inc Past Accepting new patients
Overland Optical, Inc. Past Accepting new patients
Rosen Optometry Associates Inc Optometrist Past Accepting new patients
Daniel & Max Optometrist PastSince Feb 21, 2021 Accepting new patients

Organizations & group practices 5

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": "1153353600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1431475200000",
    "number": "1881614022",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1614 N GREEN RIVER RD",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477151902",
            "telephone_number": "812-618-0423",
            "fax_number": "812-618-2866"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1614 N GREEN RIVER RD",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477151902",
            "telephone_number": "812-618-0423",
            "fax_number": "812-618-2866"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIAMSON",
        "first_name": "JILL",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-20",
        "last_updated": "2015-05-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MO",
            "license": "2005020671",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046.009784",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IN",
            "license": "18003661A",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1881614022",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Evansville, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.