MEDICARE: DR. MAURICE JOE WILSON O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	3708TG	TX
2	152WC0802X	Corneal and Contact Management Optometrist	3708TG	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1881601565
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MAURICE JOE WILSON O.D.

Provider Business Mailing Address
First Line	:	1409 N LOOP 336 W
Second Line	:
City	:	CONROE
State	:	TX
Zip	:	77304-3503
Country	:	US
Telephone Number	:	936-788-2551
Fax Number	:	936-788-2551

Provider Business Practice Location Address
First Line	:	1409 N LOOP 336 W
Second Line	:
City	:	CONROE
State	:	TX
Zip	:	77304-3503
Country	:	US
Telephone Number	:	936-788-2551
Fax Number	:	936-788-2551

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/02/2006
Last Update Date	:	02/24/2026

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