Provider Demographics
NPI:1508855537
Name:WILLIAMS, LANELLE SHELLEMIAH (OD)
Entity Type:Individual
Prefix:
First Name:LANELLE
Middle Name:SHELLEMIAH
Last Name:WILLIAMS
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 1:5333 N DIXIE HWY
Mailing Address - Street 2:101
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33334-3414
Mailing Address - Country:US
Mailing Address - Phone:954-493-5033
Mailing Address - Fax:954-493-5058
Practice Address - Street 1:1701 NE 164TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-4018
Practice Address - Country:US
Practice Address - Phone:305-947-0027
Practice Address - Fax:305-945-8734
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3294152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL410045725OtherRAILROAD MEDICARE
FL620413900Medicaid
FL20845OtherBLUE CROSS BLUE SHIELD
FL410045724OtherRAILROAD MEDICARE
FL410045725OtherRAILROAD MEDICARE
FL410045724OtherRAILROAD MEDICARE
FL20845ZMedicare PIN