Provider Demographics
NPI:1972791382
Name:SHELLEY WILLIAMS O.D., P.C.
Entity Type:Organization
Organization Name:SHELLEY WILLIAMS O.D., P.C.
Other - Org Name:WILLIAMS & HUSSEY EYECARE/ EYEDENTITY EYEWEAR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:W
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:573-445-8780
Mailing Address - Street 1:2200 FORUM BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-2700
Mailing Address - Country:US
Mailing Address - Phone:573-445-8780
Mailing Address - Fax:573-446-2318
Practice Address - Street 1:2200 FORUM BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-2700
Practice Address - Country:US
Practice Address - Phone:573-445-8780
Practice Address - Fax:573-446-2318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-10
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT02968152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty