Organization
WILSON EYECARE PROFESSIONALS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DOUGLAS J WILSON O.D. (CEO AND DOCTOR)
(317) 477-3937
Entity
Organization
Contact information
Practice address
400 W GREEN MEADOWS DR, SUITE 108, GREENFIELD, IN 46140-3204
(317) 477-3937
(317) 477-3939
Mailing address
400 W GREEN MEADOWS DR, SUITE 108, GREENFIELD, IN 46140-3204
(317) 477-3937
(317) 477-3939
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
18002895AB
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000176992
ANTHEM BLUE CROSS AND BLUE SHIELD
IN
05
—
200280210
—
IN
01
—
IN2895
EYEMED
IN
01
—
JARTL
VSP
IN
Enumeration date
09/27/2011
Last updated
12/13/2011
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