Individual
ROGER LEWIS WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
7721 E MAIN ST, REYNOLDSBURG, OH 43068-1211
(614) 861-0950
(614) 861-5665
Mailing address
7721 E MAIN ST, REYNOLDSBURG, OH 43068-1211
(614) 861-0950
(614) 861-5665
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3318
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000119534
ANTHEM PROVIDER ID
OH
01
—
142757
EYEMED ID
OH
01
—
2200501
UNITED HEALTH CARE
OH
Enumeration date
10/24/2006
Last updated
07/21/2010
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