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General NPI Number Information
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NPI Number | 1023406766
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Entity Type | Organization
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Legal Business Name | WILSON VISION ASSOCIATES PC
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Dates
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Enumeration Date | 01/05/2015
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Last Update Date | 03/16/2015
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Provider Practice Location Address
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Address Line | 1409 N LOOP 336 W
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City | CONROE
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State | TX
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Zip | 77304-3503
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Country | US
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Telephone | 936-788-2551
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Fax | 936-788-2552
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Provider Business Mailing Address
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Address Line | 1409 N LOOP 336 W
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City | CONROE
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State | TX
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Zip | 77304-3503
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Country | US
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Telephone | 936-788-2551
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Fax | 936-788-2552
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. MAURICE WILSON
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Credential | O.D.
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Telephone | 936-788-2551
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | 3708TG
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License Number State | TX
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