Provider Demographics
NPI:1801969688
Name:WILLIAMS, SHAY DELSON (OD)
Entity type:Individual
Prefix:DR
First Name:SHAY
Middle Name:DELSON
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8819 MACEDONIA RD
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38506-6868
Mailing Address - Country:US
Mailing Address - Phone:931-310-5128
Mailing Address - Fax:931-354-7015
Practice Address - Street 1:1102 N GATEWAY AVE
Practice Address - Street 2:
Practice Address - City:ROCKWOOD
Practice Address - State:TN
Practice Address - Zip Code:37854-4012
Practice Address - Country:US
Practice Address - Phone:865-354-3414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2018-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNODT2247152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3944316Medicaid
TNU85226Medicare UPIN
TN3944316Medicare ID - Type Unspecified