Individual
DR. ROGER W WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
1551 E STOP 12 RD, INDIANAPOLIS, IN 46227-1006
(317) 883-4970
Mailing address
282 WAKEFIELD DR E, GREENWOOD, IN 46142-8801
(317) 881-0507
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
18003054A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
IN3054
EYEMED VISION NO.
—
Enumeration date
07/31/2006
Last updated
01/04/2008
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