Provider Demographics
NPI:1568812709
Name:WILLIAMSON, ANTHONY TYLER (OD)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:TYLER
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 1:2555 95TH ST
Mailing Address - Street 2:APT 608
Mailing Address - City:PORT ARTHUR
Mailing Address - State:TX
Mailing Address - Zip Code:77640-1552
Mailing Address - Country:US
Mailing Address - Phone:903-570-6092
Mailing Address - Fax:
Practice Address - Street 1:3429 N TWIN CITY HWY
Practice Address - Street 2:
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77642-2102
Practice Address - Country:US
Practice Address - Phone:409-963-0173
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-19
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8932T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8932TOtherTEXAS OPTOMETRY LICENSE