Individual
JACOB WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
2033-1 N SPRUCE, TUBA CITY, AZ 86045
(602) 576-2812
Mailing address
167 N MAIN ST, TUBA CITY, AZ 86045
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
733279
AZ
Other
Enumeration date
06/08/2023
Last updated
06/08/2023
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