Healthcare Provider Details

I. General information

NPI: 1518287788
Provider Name (Legal Business Name): WILLIAMSON EYE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2010
Last Update Date: 06/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3403 PERKINS ROAD SUITE 3
BATON ROUGE LA
70808
US

IV. Provider business mailing address

3403 PERKINS ROAD SUITE 3
BATON ROUGE LA
70808
US

V. Phone/Fax

Practice location:
  • Phone: 225-383-3937
  • Fax: 225-383-3038
Mailing address:
  • Phone: 225-383-3937
  • Fax: 225-383-3038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. CHARLES H. WILLIAMSON SR.
Title or Position: MD, MEDICAL DIRECTOR, OWNER
Credential: M.D.
Phone: 225-924-2020