Organization
WILSON OPTOMETRY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DOUGLAS JAMES WILSON OD (DOCTOR OWNER)
(317) 477-3937
Entity
Organization
Contact information
Practice address
400 W GREEN MEADOWS DR, SUITE 108, GREENFIELD, IN 46140-3204
(317) 477-3937
(317) 477-3937
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
—
410043699
MEDICARE RAILROAD
IN
01
—
IN2895
EYEMED
IN
01
—
JARTL
VSP
IN
Enumeration date
12/12/2007
Last updated
07/19/2012
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