Provider Demographics
NPI:1851496558
Name:DON E WILLIAMSON ODPA
Entity Type:Organization
Organization Name:DON E WILLIAMSON ODPA
Other - Org Name:WILLIAMSON EYE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRAITOR
Authorized Official - Prefix:
Authorized Official - First Name:DONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-542-2504
Mailing Address - Street 1:3218 DEL PRADO BLVD S
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33904-7203
Mailing Address - Country:US
Mailing Address - Phone:239-542-2504
Mailing Address - Fax:239-542-5633
Practice Address - Street 1:3218 DEL PRADO BLVD S
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33904-7203
Practice Address - Country:US
Practice Address - Phone:239-542-2504
Practice Address - Fax:239-542-5633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 870152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL74821OtherBCBS FLORIDA
FL620899100Medicaid
FLDS7497Medicare PIN
FL74821OtherBCBS FLORIDA
FLCU465AMedicare PIN