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General NPI Number Information
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NPI Number | 1437475126
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Entity Type | Organization
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Legal Business Name | GENE E. WYLL, M.D., P.A.
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Dates
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Enumeration Date | 04/20/2010
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Last Update Date | 04/20/2010
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Provider Practice Location Address
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Address Line | 610 N COIT RD SUITE 2115
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City | RICHARDSON
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State | TX
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Zip | 75080-5457
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Country | US
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Telephone | 214-575-4455
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Fax | 972-918-0480
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Provider Business Mailing Address
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Address Line | 610 N COIT RD SUITE 2115
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City | RICHARDSON
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State | TX
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Zip | 75080-5457
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Country | US
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Telephone | 214-575-4455
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Fax | 972-918-0480
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Authorized Official
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Title or Position | PRESIDENT
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Name | GENE WYLL
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Credential | M.D.
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Telephone | 214-575-4455
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | D9731
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License Number State | TX
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