Individual
DR. WILSON W. MOVIC
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
2103 E WASHINGTON ST, BLOOMINGTON, IL 61701-4310
(309) 662-2277
(309) 663-6472
Mailing address
2103 E WASHINGTON ST, BLOOMINGTON, IL 61701-4310
(309) 662-2277
(309) 663-6472
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046-007251
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0005784008
BCBS
IL
05
—
046007251
—
IL
Enumeration date
07/30/2006
Last updated
06/11/2008
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