Individual
DR. TIMOTHY N WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
7601 UNIVERSITY AVE, #102, MIDDLETON, WI 53562-5414
(608) 831-3366
(608) 831-8470
Mailing address
7601 UNIVERSITY AVE, #102, MIDDLETON, WI 53562-5414
(608) 831-3366
(608) 831-8470
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046009848
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
046009848
STATE LICENSE
IL
01
—
3108-035
STATE LICENSE
WI
01
—
OPT-2565
STATE LICENSE
CO
Enumeration date
09/22/2006
Last updated
06/27/2013
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