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General NPI Number Information
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NPI Number | 1477966026
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Entity Type | Individual
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Provider Name | ANDREW WILSON O.D.
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Gender | Male
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Dates
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Enumeration Date | 06/10/2014
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Last Update Date | 10/30/2014
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Provider Practice Location Address
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Address Line | 4000 CALLE TECATE #100
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City | CAMARILLO
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State | CA
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Zip | 93012-5282
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Country | US
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Telephone | 805-482-1136
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Fax | 805-388-8499
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Provider Business Mailing Address
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Address Line | 4000 CALLE TECATE SUITE 100
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City | CAMARILLO
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State | CA
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Zip | 93012-5282
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Country | US
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Telephone | 805-482-1136
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Fax | 805-388-8499
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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 | 14926
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License Number State | CA
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