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General NPI Number Information
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NPI Number | 1558427286
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Entity Type | Individual
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Provider Name | LORRI B WILSON MD
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Gender | Female
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Dates
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Enumeration Date | 12/28/2006
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Last Update Date | 11/02/2017
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Provider Practice Location Address
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Address Line | 3375 SW TERWILLIGER BLVD
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City | PORTLAND
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State | OR
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Zip | 97239-4146
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Country | US
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Telephone | 215-292-2953
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Fax |
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Provider Business Mailing Address
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Address Line | 3375 SW TERWILLIGER BLVD
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City | PORTLAND
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State | OR
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Zip | 97239-4146
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Country | US
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Telephone | 503-494-3000
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Fax | 503-494-4286
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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 | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | MD154363
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 207WX0110X
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Taxonomy Name | Pediatric Ophthalmology and Strabismus Specialist Physician Physician
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License Number | MD154363
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License Number State | OR
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