Individual
DOUGLAS MARK WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
71 ALLEN ST, STE 201, RUTLAND, VT 05701
(802) 775-9355
(802) 775-4577
Mailing address
71 ALLEN ST, STE 201, RUTLAND, VT 05701
(802) 775-9355
(802) 775-4577
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
0300000152
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
OVN0576
—
VT
Enumeration date
03/24/2006
Last updated
09/26/2013
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