Individual
DR. KAMRIAN SUE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
690 MISSOURI AVE., SUITE 22, ST. ROBERT, MO 65584
(573) 336-4670
(573) 336-5968
Mailing address
690 MISSOURI AVE., SUITE 22, ST. ROBERT, MO 65584-4680
(573) 336-4670
(573) 336-5968
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
TO3060
MO
152WC0802X
Corneal and Contact Management Optometrist
TO3060
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
313540411
—
MO
05
—
313540411MO
—
MO
Enumeration date
06/28/2006
Last updated
08/27/2014
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