MEDICARE: WILLIAMSON EYE CENTER

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	152WC0802X	Corneal and Contact Management Optometrist
2	332H00000X	Eyewear Supplier
3	363A00000X	Physician Assistant
4	152W00000X	Optometrist	20093	LA
5	207W00000X	Ophthalmology Physician	20093	LA

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	:	1841295813
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILLIAMSON EYE CENTER

Provider Business Mailing Address
First Line	:	2290 S RANGE AVE
Second Line	:
City	:	DENHAM SPRINGS
State	:	LA
Zip	:	70726-5214
Country	:	US
Telephone Number	:	225-665-2019
Fax Number	:	225-665-2089

Provider Business Practice Location Address
First Line	:	2290 S RANGE AVE
Second Line	:
City	:	DENHAM SPRINGS
State	:	LA
Zip	:	70726-5214
Country	:	US
Telephone Number	:	225-665-2019
Fax Number	:	225-665-2089

Authorized Official
Title or Position	:	MD, MEDICAL DIRECTOR, OWNER
Name	:	DR. CHARLES HAMILTON WILLIAMSON
Credential	:	MD
Telephone Number	:	225-924-2020

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	08/12/2010

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Directions to “WILLIAMSON EYE CENTER ” Practice Location

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