=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518121938
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICHELLE MUNN WILLIAMS O.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/15/2008
-----------------------------------------------------
Last Update Date | 01/12/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7252 FM 35
-----------------------------------------------------
City | ROYSE CITY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75189-9701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-636-3937
-----------------------------------------------------
Fax | 972-635-9899
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 845
-----------------------------------------------------
City | ROYSE CITY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75189-0845
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-636-3937
-----------------------------------------------------
Fax | 972-635-9899
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 7221T
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------