Individual
DR. PHILIP MARC WILMOTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
709 MORGANTOWN AVE, FAIRMONT, WV 26554
(304) 366-4721
(304) 366-4847
Mailing address
PO BOX 2618, FAIRMONT, WV 26554-2618
(304) 366-4721
(304) 366-4847
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
78700
WV
152WC0802X
Corneal and Contact Management Optometrist
78700
WV
152WL0500X
Low Vision Rehabilitation Optometrist
78700
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
015096400
—
WV
Enumeration date
04/11/2006
Last updated
12/17/2009
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