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General NPI Number Information
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NPI Number | 1972791382
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Entity Type | Organization
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Legal Business Name | SHELLEY WILLIAMS O.D., P.C.
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Dates
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Enumeration Date | 10/10/2007
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Last Update Date | 10/12/2007
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Provider Practice Location Address
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Address Line | 2200 FORUM BLVD SUITE 102
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City | COLUMBIA
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State | MO
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Zip | 65203-2700
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Country | US
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Telephone | 573-445-8780
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Fax | 573-446-2318
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Provider Business Mailing Address
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Address Line | 2200 FORUM BLVD SUITE 102
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City | COLUMBIA
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State | MO
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Zip | 65203-2700
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Country | US
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Telephone | 573-445-8780
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Fax | 573-446-2318
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | MRS. SHELLEY W WILLIAMS
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Credential | O.D.
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Telephone | 573-445-8780
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | T02968
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License Number State | MO
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