Healthcare Provider Details

I. General information

NPI: 1841295813
Provider Name (Legal Business Name): WILLIAMSON EYE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 08/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2290 S RANGE AVE
DENHAM SPRINGS LA
70726-5214
US

IV. Provider business mailing address

2290 S RANGE AVE
DENHAM SPRINGS LA
70726-5214
US

V. Phone/Fax

Practice location:
  • Phone: 225-665-2019
  • Fax: 225-665-2089
Mailing address:
  • Phone: 225-665-2019
  • Fax: 225-665-2089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number20093
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number20093
License Number StateLA
# 4
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

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