Individual
DR. TIMOTHY JON WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
2413 WARDS RD, LYNCHBURG, VA 24502-2103
(434) 239-5323
Mailing address
2413 WARDS RD, LYNCHBURG, VA 24502-2103
(434) 239-5323
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
0618000530
VA
152W00000X
Optometrist
0618000652
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9230122
—
VA
05
—
9234501
—
VA
Enumeration date
07/03/2006
Last updated
07/01/2011
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