Healthcare Provider Details

I. General information

NPI: 1487582946
Provider Name (Legal Business Name): KENANIAH WILLIAMSON OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 TROJAN LN
NEW CASTLE IN
47362-2966
US

IV. Provider business mailing address

375 TROJAN LN
NEW CASTLE IN
47362-2966
US

V. Phone/Fax

Practice location:
  • Phone: 765-521-0675
  • Fax:
Mailing address:
  • Phone: 765-521-0675
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number18004647A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: