MEDICARE: ANDERSON OPTOMETRIC ASSOCIATES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174504401
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANDERSON OPTOMETRIC ASSOCIATES

Provider Business Mailing Address
First Line	:	PO BOX 838
Second Line	:
City	:	ANDERSON
State	:	SC
Zip	:	29622-0838
Country	:	US
Telephone Number	:	864-226-6005
Fax Number	:	864-225-1139

Provider Business Practice Location Address
First Line	:	1220 N FANT ST
Second Line	:
City	:	ANDERSON
State	:	SC
Zip	:	29621-4822
Country	:	US
Telephone Number	:	864-226-6005
Fax Number	:	864-225-1139

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MARION K WILLIAMS
Credential	:	OPTOMETRIST
Telephone Number	:	864-847-4440

Provider Enumeration Date	:	11/14/2005
Last Update Date	:	10/15/2008

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