Provider Demographics
NPI:1184768210
Name:WILLIAMSON, BEVERLY (OD)
Entity type:Individual
Prefix:DR
First Name:BEVERLY
Middle Name:
Last Name:WILLIAMSON
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 1:7355 S SOUTH SHORE DR
Mailing Address - Street 2:APT. 407
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60649-3925
Mailing Address - Country:US
Mailing Address - Phone:773-721-0011
Mailing Address - Fax:
Practice Address - Street 1:200 RIVER OAKS DRIVE
Practice Address - Street 2:
Practice Address - City:CALUMET CITY
Practice Address - State:IL
Practice Address - Zip Code:60409
Practice Address - Country:US
Practice Address - Phone:708-868-4286
Practice Address - Fax:708-868-2717
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046.008532152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist