Individual
BRADY L WILBORN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
202 E NORTH ST, CALIFORNIA, MO 65018-1583
(573) 796-2222
(573) 796-4184
Mailing address
202 E NORTH ST, CALIFORNIA, MO 65018-1583
(573) 796-2222
(573) 796-4184
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
1608
KS
152W00000X
Optometrist
Primary
168620
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100406140B
—
KS
Enumeration date
07/07/2005
Last updated
07/19/2007
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