MEDICARE: SHELLEY WILLIAMS O.D., P.C.

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	T02968	MO

General Provider Information

NPI Number	:	1972791382
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHELLEY WILLIAMS O.D., P.C.

Provider Business Mailing Address
First Line	:	2200 FORUM BLVD
Second Line	:	SUITE 102
City	:	COLUMBIA
State	:	MO
Zip	:	65203-2700
Country	:	US
Telephone Number	:	573-445-8780
Fax Number	:	573-446-2318

Provider Business Practice Location Address
First Line	:	2200 FORUM BLVD
Second Line	:	SUITE 102
City	:	COLUMBIA
State	:	MO
Zip	:	65203-2700
Country	:	US
Telephone Number	:	573-445-8780
Fax Number	:	573-446-2318

Authorized Official
Title or Position	:	OWNER/MANAGER
Name	:	MRS. SHELLEY W WILLIAMS
Credential	:	O.D.
Telephone Number	:	573-445-8780

Provider Enumeration Date	:	10/10/2007
Last Update Date	:	10/12/2007

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