Provider Demographics
NPI:1831183060
Name:WILLIAMSON, JAMES ALLAN (OD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:ALLAN
Last Name:WILLIAMSON
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 1:1689 NONCONNAH BLVD STE 120
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38132-2111
Mailing Address - Country:US
Mailing Address - Phone:901-523-8990
Mailing Address - Fax:901-522-3436
Practice Address - Street 1:1689 NONCONNAH BLVD STE 120
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38132-2111
Practice Address - Country:US
Practice Address - Phone:901-523-8990
Practice Address - Fax:901-522-3436
Is Sole Proprietor?:No
Enumeration Date:2005-09-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1866152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3942042Medicaid
TN1866OtherOD
TN1866OtherOD
MW0400553OtherDEA
U72134Medicare UPIN