Individual
DR. DAVID RUSSELL WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
650 E HIGH ST, STE 652, CARLISLE, PA 17013
(717) 258-4422
(717) 258-4245
Mailing address
19336 LEITERSBURG PIKE, HAGERSTOWN, MD 21742
(717) 258-4422
(717) 258-4245
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
0618001399
VA
152W00000X
Optometrist
Primary
OEG001476
PA
152W00000X
Optometrist
TA1894
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1011408310002
—
PA
01
—
64392302
CAREFIRST BLUE CROSS BLUE
MD
01
—
WI1634058
HIGHMARK BLUE SHIELD
PA
Enumeration date
10/26/2006
Last updated
07/08/2007
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