Organization
DOUGLAS R. WILSON, MD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DOUGLAS R WILSON MD (OWNER)
(812) 375-9390
Entity
Organization
Contact information
Practice address
3902 25TH ST, COLUMBUS, IN 47203-3007
(812) 375-9390
Mailing address
PO BOX 68952, INDIANAPOLIS, IN 46268-0952
(317) 802-3126
(317) 870-0499
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200890470
—
IN
Enumeration date
08/25/2006
Last updated
03/09/2009
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