Individual
DR. RYAN J WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
112 S CENTER ST, GENESEO, IL 61254-1338
(309) 944-5303
(309) 944-3465
Mailing address
112 S CENTER ST, GENESEO, IL 61254-1338
(309) 944-5303
(309) 944-3465
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046009598
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
046009598
—
IL
01
—
977130
IL GROUP MEDICARE
—
Enumeration date
12/21/2005
Last updated
02/16/2024
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