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Individual

DR. DOUGLAS J WILSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
OD

Contact information

Practice address
400 W GREEN MEADOWS DR, SUITE 108, GREENFIELD, IN 46140-3204
(317) 477-3937
(317) 477-3939
Mailing address
400 W GREEN MEADOWS DR, SUITE 108, GREENFIELD, IN 46140-3204
(317) 477-3937
(317) 477-3939

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
18002895A/B
IN
152WC0802X
Corneal and Contact Management Optometrist
18002895A/B
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000176992
BCBS
IN
05
200280210A
IN
01
410043699
RAILROAD MEDICARE
IN
01
IN2895
EYEMED
IN
01
JARTL
EYEFINITY
IN
Enumeration date
07/15/2005
Last updated
12/13/2011
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