Healthcare Provider Details

I. General information

NPI: 1710969969
Provider Name (Legal Business Name): MARION K WILLIAMS OPTOMETRIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2005
Last Update Date: 08/15/2024
Certification Date: 08/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 E MAIN ST
WILLIAMSTON SC
29697-1912
US

IV. Provider business mailing address

PO BOX 896189
CHARLOTTE NC
28289-6189
US

V. Phone/Fax

Practice location:
  • Phone: 864-847-4440
  • Fax:
Mailing address:
  • Phone: 864-654-6706
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number900
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: