MEDICARE: KENANIAH WILLIAMSON OD

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
1	152W00000X	Optometrist	18004647A	IN

General Provider Information

NPI Number	:	1487582946
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENANIAH WILLIAMSON OD

Provider Business Mailing Address
First Line	:	375 TROJAN LN
Second Line	:
City	:	NEW CASTLE
State	:	IN
Zip	:	47362-2966
Country	:	US
Telephone Number	:	765-521-0675
Fax Number	:

Provider Business Practice Location Address
First Line	:	375 TROJAN LN
Second Line	:
City	:	NEW CASTLE
State	:	IN
Zip	:	47362-2966
Country	:	US
Telephone Number	:	765-521-0675
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/13/2026
Last Update Date	:	05/13/2026

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