Individual
MICHAEL DAVID WESSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
5001 TAYLOR ROAD, PUNTA GORDA, FL 33950-4722
(941) 575-0903
(941) 575-0905
Mailing address
5001 TAYLOR ROAD, PUNTA GORDA, FL 33950-4722
(941) 575-0903
(941) 575-0905
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
OPC0843
FL
152W00000X
Optometrist
Primary
OPT002219
GA
152W00000X
Optometrist
R117-TA-093
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
084066100
—
FL
01
—
20767
BLUE CROSS BLUE SHIELD
FL
01
—
20767A
MEDICARE ID - TYPE UNSPECIFIED
FL
Enumeration date
03/31/2006
Last updated
04/22/2022
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