Individual
JON PRESTON WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
165 W 200 N, 71-7, ROOSEVELT, UT 84066-2834
(435) 722-2981
(435) 722-3732
Mailing address
165 W 200 N, 71-7, ROOSEVELT, UT 84066-2834
(435) 722-2981
(435) 722-3732
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4944063-9934
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000012521
MEDICARE LEGACY NUMBER
UT
01
—
1015
OPTICARE
UT
01
—
49440639900001
BCBS
UT
01
—
67467
PEHP
—
01
—
87041538400001
NTCA
—
01
—
870444057
VSP
—
01
—
UT4063
EYEMED
—
Enumeration date
09/15/2005
Last updated
06/18/2008
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