MEDICARE: DR. SHELLEY WILLIAMS 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	TO2968	MO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	000009118	OTHER	MO	MEDICARE GROUP

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	108696	OTHER	MO	BCBS

General Provider Information

NPI Number	:	1750384111
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHELLEY WILLIAMS O.D.

Provider Business Mailing Address
First Line	:	302 LONGFELLOW LN
Second Line	:
City	:	COLUMBIA
State	:	MO
Zip	:	65203-1625
Country	:	US
Telephone Number	:	573-446-1139
Fax Number	:	573-445-8782

Provider Business Practice Location Address
First Line	:	2200 FORUM BLVD
Second Line	:	102
City	:	COLUMBIA
State	:	MO
Zip	:	65203-2700
Country	:	US
Telephone Number	:	573-445-8780
Fax Number	:	573-445-8782

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

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	02/25/2009

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