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General NPI Number Information
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NPI Number | 1548572530
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Entity Type | Individual
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Provider Name | LADONA JEAN WILSON O.D.
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Gender | Female
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Dates
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Enumeration Date | 07/08/2010
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1102 N MASSEY BLVD
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City | NIXA
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State | MO
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Zip | 65714-7607
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Country | US
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Telephone | 417-724-1301
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Fax |
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Provider Business Mailing Address
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Address Line | 1102 N MASSEY BLVD
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City | NIXA
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State | MO
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Zip | 65714-7607
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Country | US
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Telephone | 417-724-1301
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Fax |
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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 | 2669
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License Number State | AR
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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 | 2010022297
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License Number State | MO
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