Organization
MICHAEL LYLE WILSON PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARIE BELLVILLE (ASSISTANT)
(906) 341-5689
Entity
Organization
Contact information
Practice address
101 WALNUT ST, MANISTIQUE, MI 49854-1435
(906) 341-5689
(906) 341-5723
Mailing address
101 WALNUT ST, MANISTIQUE, MI 49854-1435
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
02482
MI
332B00000X
Durable Medical Equipment & Medical Supplies
02482
MI
Other
Enumeration date
03/28/2008
Last updated
02/21/2013
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