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NPI Code Detail

MEDICARE: DR. BEVERLY WILLIAMSON O.D.

MEDICARE:  DR. BEVERLY  WILLIAMSON  O.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist046.008532IL

General Provider Information

NPI Number : 1184768210
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BEVERLY WILLIAMSON O.D.
Provider Business Mailing Address
First Line : 7355 S SOUTH SHORE DR
Second Line : APT. 407
City : CHICAGO
State : IL
Zip : 60649-3925
Country : US
Telephone Number : 773-721-0011
Fax Number :
Provider Business Practice Location Address
First Line : 200 RIVER OAKS DRIVE
Second Line :
City : CALUMET CITY
State : IL
Zip : 60409
Country : US
Telephone Number : 708-868-4286
Fax Number : 708-868-2717
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/20/2007
Last Update Date : 07/08/2007

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Directions to “ DR. BEVERLY WILLIAMSON O.D.” Practice Location

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