DR. JOSHUA WILLIAMS – Optometrist, NPI 1104796473

DR. JOSHUA WILLIAMS is a healthcare provider. based in Ham lake, Minnesota. specializing in OPTOMETRY. They hold a License No. 4033 (MN). The NPI Number for DR. JOSHUA WILLIAMS is 1104796473

Main info

Male
Sole Proprietor
1 Year Of Experience
Accepts Medicare Assignment
Name
DR. JOSHUA WILLIAMS
NPI
1104796473
Phone
Not provided
Address
14212 LONDON ST NE
Enumeration Date
10 November 2025
Last Update Date
10 November 2025

Doctor Profile

Medical School Name
OTHER
Secondary Phone
6516381555
Graduation Year
2025 (1 year ago)
PAC ID
7416434022
Group Practice PAC ID
6709781180
Professional Enrollment ID
I20260123003274
Address ID
MN551131364RO1835XWXXX501
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience24
Completeness85
Years active:0State licenses:1Digital endpointsOther names

879 OPTOMETRY in MN

Provider Addresses for DR. JOSHUA WILLIAMS

  • 14212 LONDON ST NE

    HAM LAKE, MN 553046820

    Phone:

    Type: Mailing

  • 3480 BUNKER LAKE BLVD NW STE 101

    ANDOVER, MN 553043669

    Phone: (763) 712-9854

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2026-01-23

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20260123003274IOptometryMNTBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 55304)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 6709781180View full group profile
NameSpecialtyState
-MN
O P T O M E T R YMN
O P T O M E T R YMN

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Frequently asked questions

What unique ID ties claims to DR. JOSHUA WILLIAMS?
NPI 1104796473 is assigned to DR. JOSHUA WILLIAMS under the national enumeration system.
Is DR. JOSHUA WILLIAMS active in the national directory?
DR. JOSHUA WILLIAMS's public NPI profile is in an active state.
What does DR. JOSHUA WILLIAMS treat or focus on?
Patients typically see DR. JOSHUA WILLIAMS under the specialty Optometrist. Clinical services aligned with this taxonomy classification.
Does DR. JOSHUA WILLIAMS practice in Minnesota?
You will see Ham Lake, Minnesota on file for DR. JOSHUA WILLIAMS alongside any extra practice locations.
What if Ham Lake, Minnesota seems incomplete?
Street-level detail can be omitted — open the full address list for this NPI.

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