MEDICARE: CHASE MORGAN WILSON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	U3057	TX

General Provider Information

NPI Number	:	1255994844
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHASE MORGAN WILSON MD

Provider Business Mailing Address
First Line	:	2855 GRAMERCY ST STE 400
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77025-1756
Country	:	US
Telephone Number	:	713-668-6828
Fax Number	:

Provider Business Practice Location Address
First Line	:	1100 GULF FWY S STE 114
Second Line	:
City	:	LEAGUE CITY
State	:	TX
Zip	:	77573-5148
Country	:	US
Telephone Number	:	281-332-3937
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/18/2019
Last Update Date	:	07/20/2023

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