Provider Demographics
NPI:1336678333
Name:WILLIAMSON, AMANDA KATHERINE (OD)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:KATHERINE
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 1:5114 CASA RICA ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78233-6435
Mailing Address - Country:US
Mailing Address - Phone:972-302-1521
Mailing Address - Fax:
Practice Address - Street 1:17460 IH 35 N STE 412
Practice Address - Street 2:
Practice Address - City:SCHERTZ
Practice Address - State:TX
Practice Address - Zip Code:78154-1222
Practice Address - Country:US
Practice Address - Phone:210-590-2482
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-05
Last Update Date:2017-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9250T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist