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General NPI Number Information
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NPI Number | 1235138876
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Entity Type | Individual
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Provider Name | DOUGLAS J WILSON OD
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Gender | Male
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Dates
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Enumeration Date | 07/15/2005
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Last Update Date | 12/13/2011
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Provider Practice Location Address
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Address Line | 400 W GREEN MEADOWS DR SUITE 108
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City | GREENFIELD
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State | IN
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Zip | 46140-3204
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Country | US
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Telephone | 317-477-3937
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Fax | 317-477-3939
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Provider Business Mailing Address
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Address Line | 400 W GREEN MEADOWS DR SUITE 108
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City | GREENFIELD
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State | IN
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Zip | 46140-3204
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Country | US
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Telephone | 317-477-3937
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Fax | 317-477-3939
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 18002895A/B
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | 18002895A/B
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License Number State | IN
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