MEDICARE: DR. ANTHONY TYLER 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
1	152W00000X	Optometrist	8932T	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8932T	OTHER	TX	TEXAS OPTOMETRY LICENSE

General Provider Information

NPI Number	:	1568812709
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANTHONY TYLER WILLIAMSON O.D.

Provider Business Mailing Address
First Line	:	2555 95TH ST
Second Line	:	APT 608
City	:	PORT ARTHUR
State	:	TX
Zip	:	77640-1552
Country	:	US
Telephone Number	:	903-570-6092
Fax Number	:

Provider Business Practice Location Address
First Line	:	3429 N TWIN CITY HWY
Second Line	:
City	:	PORT ARTHUR
State	:	TX
Zip	:	77642-2102
Country	:	US
Telephone Number	:	409-963-0173
Fax Number	:

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

Provider Enumeration Date	:	06/19/2016
Last Update Date	:	08/10/2016

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Directions to “ DR. ANTHONY TYLER WILLIAMSON O.D.” Practice Location

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