Provider Demographics
NPI:1215021910
Name:WILLIAMSON, VERNESSA N (OD)
Entity Type:Individual
Prefix:
First Name:VERNESSA
Middle Name:N
Last Name:WILLIAMSON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402A E EDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:FRIENDSWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77546-3825
Mailing Address - Country:US
Mailing Address - Phone:281-482-7006
Mailing Address - Fax:
Practice Address - Street 1:402A E EDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:FRIENDSWOOD
Practice Address - State:TX
Practice Address - Zip Code:77546-3825
Practice Address - Country:US
Practice Address - Phone:281-482-7006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5043T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU56998Medicare UPIN
TX81080EMedicare PIN