MEDICARE: LANELLE SHELLEMIAH WILLIAMS 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	OPC3294	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	410045725	OTHER	FL	RAILROAD MEDICARE
4	410045724	OTHER	FL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	20845	OTHER	FL	BLUE CROSS BLUE SHIELD
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508855537
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LANELLE SHELLEMIAH WILLIAMS OD

Provider Business Mailing Address
First Line	:	5333 N DIXIE HWY
Second Line	:	101
City	:	OAKLAND PARK
State	:	FL
Zip	:	33334-3414
Country	:	US
Telephone Number	:	954-493-5033
Fax Number	:	954-493-5058

Provider Business Practice Location Address
First Line	:	1701 NE 164TH ST
Second Line	:	SUITE 200
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33162-4018
Country	:	US
Telephone Number	:	305-947-0027
Fax Number	:	305-945-8734

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

Provider Enumeration Date	:	10/21/2005
Last Update Date	:	10/14/2010

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Directions to “ LANELLE SHELLEMIAH WILLIAMS OD” Practice Location

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