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Organization
CHARLES R WILDER OD PC
Active
Organization
CHARLES R WILDER OD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES ROMEO WILDER II OD (PRESIDENT)
(734) 782-7200
Entity
Organization
Contact information
Practice address
15401 HARRIET ST, ROMULUS, MI 48174-3069
(734) 782-7200
(734) 229-9558
Mailing address
15401 HARRIET ST, ROMULUS, MI 48174-3069
(734) 782-7200
(734) 229-9558
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
4901002266
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5006929
—
MI
Enumeration date
05/04/2011
Last updated
05/04/2011
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