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General NPI Number Information
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NPI Number | 1336431923
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Entity Type | Organization
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Legal Business Name | WILSON & BERNATSKY P A
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Dates
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Enumeration Date | 05/13/2011
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Last Update Date | 08/05/2013
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Provider Practice Location Address
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Address Line | 655 BRANDON TOWN CENTER MALL
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City | BRANDON
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State | FL
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Zip | 33511-4770
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Country | US
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Telephone | 813-681-1036
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Fax |
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Provider Business Mailing Address
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Address Line | 655 BRANDON TOWN CENTER MALL
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City | BRANDON
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State | FL
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Zip | 33511-4770
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Country | US
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Telephone | 813-681-1036
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. MARK WILSON
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Credential | O.D.
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Telephone | 813-977-3862
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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 | OPC001872
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License Number State | FL
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