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General NPI Number Information
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NPI Number | 1093859563
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Entity Type | Individual
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Provider Name | SIDNEY MAURICE WILSON O.D.
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Gender | Male
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Dates
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Enumeration Date | 02/17/2007
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Last Update Date | 02/17/2011
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Provider Practice Location Address
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Address Line | 6745 S SIWELL RD SUITE 106
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City | BYRAM
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State | MS
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Zip | 39272-8700
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Country | US
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Telephone | 601-373-0354
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Fax | 601-373-0321
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Provider Business Mailing Address
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Address Line | 6745 S SIWELL RD SUITE 106
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City | BYRAM
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State | MS
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Zip | 39272-8700
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Country | US
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Telephone | 601-373-0354
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Fax | 601-373-0321
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 568
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License Number State | MS
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