Individual
DR. MARK DENNIS WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
314 W SAVIDGE ST, SPRING LAKE, MI 49456-1607
(616) 844-7000
(616) 844-7444
Mailing address
105 W EXCHANGE ST, SPRING LAKE, MI 49456-2024
(616) 846-0620
(616) 844-6079
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4901003705
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
(94)4830440
—
MI
01
—
201249427
TAX ID
MI
01
—
204829649
TAX ID
MI
01
—
383521610
TAX ID
MI
01
—
383628290
TAX ID
MI
01
—
900E310260
BCBS OF MICHIGAN
MI
01
—
900F111210
BCBS OF MICHIGAN
MI
01
—
900F210170
BCBS OF MICHIGAN
MI
Enumeration date
09/20/2005
Last updated
12/10/2015
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