Individual
SHAE WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1407 N RACE ST, GLASGOW, KY 42141-3490
(270) 651-6652
Mailing address
476 TIMBER RIDGE RD, LOST CREEK, WV 26385-7227
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2407DT
KY
Other
Enumeration date
04/12/2024
Last updated
07/08/2024
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