Organization
MCWILLIAMS EYECARE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KENTON L MCWILLIAMS OD (PHYSICIAN)
(636) 456-5379
Entity
Organization
Contact information
Practice address
500 WARREN COUNTY CTR, WARRENTON, MO 63383-3023
(636) 456-5379
(636) 456-5410
Mailing address
404 ANGIE DR APT D, SAINT PETERS, MO 63376-6321
(314) 276-4897
(636) 390-3959
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
T03461
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
315908707
—
MO
01
—
T03461
LICENSE ID
MO
Enumeration date
10/13/2009
Last updated
10/13/2009
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