Individual
DR. STACEY WILDA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
415 N 7TH ST, PERRY, OK 73077-6407
(580) 336-0777
(580) 336-0888
Mailing address
415 N 7TH ST, PO BOX 815, PERRY, OK 73077-6407
(580) 336-0777
(580) 336-0888
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2236
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200035140A
—
OK
Enumeration date
08/17/2005
Last updated
12/08/2008
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