Individual
DR. JONATHAN WILLIAM WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
1890 GOODMAN RD E STE 100, SOUTHAVEN, MS 38671-9504
(662) 772-5882
Mailing address
5339 SHETLAND TRL, ARLINGTON, TN 38002-8365
(901) 867-1523
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
2525
TN
152W00000X
Optometrist
Primary
722
MS
Other
Enumeration date
02/16/2007
Last updated
07/27/2012
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