MEDICARE: ADDISON P WILSON AU.D.

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	231H00000X	Audiologist	6597	OK

General Provider Information

NPI Number	:	1770221079
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADDISON P WILSON AU.D.

Provider Business Mailing Address
First Line	:	2405 S BRYANT AVE STE 100
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73013-6169
Country	:	US
Telephone Number	:	405-340-9191
Fax Number	:	405-340-9185

Provider Business Practice Location Address
First Line	:	2405 S BRYANT AVE STE 100
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73013-6169
Country	:	US
Telephone Number	:	405-340-9191
Fax Number	:	405-340-9185

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

Provider Enumeration Date	:	05/25/2022
Last Update Date	:	02/17/2026

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