Individual
CHARLES S WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
808 BUFFALO ST, FARMVILLE, VA 23901-1112
(434) 392-3375
(434) 392-3604
Mailing address
808 BUFFALO ST, FARMVILLE, VA 23901-1112
(434) 392-3375
(434) 392-3604
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
0101031065
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
004129
BLUE CROSS BLUE SHIELD
VA
01
—
276995
SOUTHERN HEALTH
—
Enumeration date
08/01/2006
Last updated
07/08/2007
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