Provider Demographics
NPI:1750384111
Name:WILLIAMS, SHELLEY (OD)
Entity type:Individual
Prefix:DR
First Name:SHELLEY
Middle Name:
Last Name:WILLIAMS
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 1:302 LONGFELLOW LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-1625
Mailing Address - Country:US
Mailing Address - Phone:573-446-1139
Mailing Address - Fax:573-445-8782
Practice Address - Street 1:2200 FORUM BLVD
Practice Address - Street 2:102
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:573-445-8782
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOTO2968152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO108696OtherBCBS
MO000009118OtherMEDICARE GROUP
MO108696OtherBCBS
MO000009118OtherMEDICARE GROUP
MOU22947Medicare UPIN