Provider Demographics
NPI:1972509156
Name:WILLIAMSON EYE CENTER
Entity Type:Organization
Organization Name:WILLIAMSON EYE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD, MEDICAL DIRECTOR, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:HAMILTON
Authorized Official - Last Name:WILLIAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:225-924-2020
Mailing Address - Street 1:5233 MAIN ST
Mailing Address - Street 2:STE A
Mailing Address - City:ZACHARY
Mailing Address - State:LA
Mailing Address - Zip Code:70791-3978
Mailing Address - Country:US
Mailing Address - Phone:225-654-0090
Mailing Address - Fax:225-654-8044
Practice Address - Street 1:5233 MAIN ST
Practice Address - Street 2:STE A
Practice Address - City:ZACHARY
Practice Address - State:LA
Practice Address - Zip Code:70791-3978
Practice Address - Country:US
Practice Address - Phone:225-654-0090
Practice Address - Fax:225-654-8044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-22
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4458152W00000X, 207W00000X
152WC0802X, 332H00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Multi-Specialty
No332H00000XSuppliersEyewear SupplierGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1797359Medicaid
LA1797359Medicaid
LA5D241Medicare ID - Type Unspecified