Individual
MS. KELLY WILSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LDO
Contact information
Practice address
174 CYPRESS POINT PKWY, PALM COAST, FL 32164-7438
(386) 446-8510
(386) 446-8512
Mailing address
4029 S PENINSULA DR, PORT ORANGE, FL 32127-6635
(386) 290-3022
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
6632
FL
Other
Enumeration date
10/11/2023
Last updated
10/11/2023
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