Individual
MR. ROBERT BRUCE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
1200 LACROSSE STREET, SUITE 105, RAPID CITY, SD 57701
(605) 348-9369
Mailing address
3146 PLAYER DRIVE, RAPID CITY, SD 57702
(605) 716-4077
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
447
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9202230
—
SD
Enumeration date
04/27/2007
Last updated
07/08/2007
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