Organization
DOUGLAS M. WILSON, O.D., P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DOUGLAS M WILSON O.D. (PRESIDENT)
(802) 775-9355
Entity
Organization
Contact information
Practice address
71 ALLEN ST STE 201, RUTLAND, VT 05701-4570
(802) 775-9355
(802) 775-4577
Mailing address
71 ALLEN ST STE 201, RUTLAND, VT 05701-4570
(802) 775-9355
(802) 775-4577
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
0300000152 VT
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0006627
—
VT
Enumeration date
05/01/2007
Last updated
04/23/2008
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