Individual
MARILYN MARIE WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
14500 US HIGHWAY 301 S, STARKE, FL 32091-7858
(904) 964-2250
(904) 964-2425
Mailing address
5901 THOMAS LN, HAMPTON, FL 32044-4466
(904) 964-2250
(904) 964-2425
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
DO4862
FL
Other
Enumeration date
08/11/2023
Last updated
08/11/2023
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