Individual
LUCAS J WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
31114 HAGGERTY RD, FARMINGTON HILLS, MI 48331-5803
(248) 788-1610
Mailing address
25090 WOODWARD AVE., #351, ROYAL OAK, MI 48067
(248) 515-5102
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
009198
NY
152W00000X
Optometrist
Primary
4901005537
MI
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
05/12/2020
Last updated
10/06/2021
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