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General NPI Number Information
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NPI Number | 1275611758
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Entity Type | Individual
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Provider Name | DENISE WILSON O.D.
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Gender | Female
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 11/30/2020
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Provider Practice Location Address
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Address Line | 27300 WIXOM RD
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City | NOVI
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State | MI
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Zip | 48374-1120
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Country | US
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Telephone | 248-349-6379
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Fax |
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Provider Business Mailing Address
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Address Line | 49676 TIMBER TRL
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City | NOVI
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State | MI
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Zip | 48374-2162
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Country | US
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Telephone | 248-505-3214
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Fax | 248-349-3874
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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 | 4901002778
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License Number State | MI
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