Individual
DR. ROGER L. WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
110 SOLANA RD, PONTE VEDRA BEACH, FL 32082-2230
(904) 280-2021
Mailing address
110 SOLANA RD, PONTE VEDRA BEACH, FL 32082-2230
(904) 280-2021
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OP2569
FL
Other
Enumeration date
09/14/2006
Last updated
07/08/2007
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