Individual
TYRONE ERVIN WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
98 DAKOTA ST APT 2, DORCHESTER, MA 02124-1270
(857) 406-9883
Mailing address
757 GALLIVAN BLVD STE 1, DORCHESTER, MA 02122-3190
(857) 406-9883
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
6629
MA
Other
Enumeration date
12/02/2024
Last updated
12/08/2024
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