Individual
MYRON WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
280 W MAIN ST, CENTRE, AL 35960-1326
(256) 927-4030
(256) 927-2586
Mailing address
280 W MAIN ST, CENTRE, AL 35960-1326
(256) 927-4030
(256) 927-2586
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
S-542-TA-135
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000059743
—
AL
Enumeration date
08/31/2006
Last updated
06/08/2010
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