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General NPI Number Information
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NPI Number | 1427055516
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Entity Type | Individual
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Provider Name | DR. RONALD B. WILSON
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Gender | Male
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Dates
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Enumeration Date | 07/05/2005
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Last Update Date | 09/19/2012
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Provider Practice Location Address
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Address Line | 4 PRINCESS RD STE 202
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City | LAWRENCEVILLE
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State | NJ
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Zip | 08648-2322
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Country | US
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Telephone | 609-219-9000
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Fax | 609-219-1313
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Provider Business Mailing Address
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Address Line | 4 PRINCESS RD STE 202
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City | LAWRENCEVILLE
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State | NJ
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Zip | 08648-2322
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Country | US
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Telephone | 609-219-9000
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Fax | 609-219-1313
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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 | 27TOA00294000
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 27TO00039900
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License Number State | NJ
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