Provider Demographics
NPI:1255319109
Name:JAMISON, WILLIAM MICHAEL (OD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:MICHAEL
Last Name:JAMISON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5330B SOUTH BLVD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28217-4116
Mailing Address - Country:US
Mailing Address - Phone:704-523-7877
Mailing Address - Fax:704-523-7862
Practice Address - Street 1:5330B SOUTH BLVD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28217-4116
Practice Address - Country:US
Practice Address - Phone:704-523-7877
Practice Address - Fax:704-523-7862
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-02
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1101152WC0802X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC09446OtherBCBS
NC7909446Medicaid
NC246408Medicare PIN
NCT64944Medicare UPIN
NC09446OtherBCBS