Doctor Name: | DR. SIDNEY MAURICE WILSON |
NPI Number: | 1093859563 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | O.D. |
License Number: | 568 |
Business Practice Address: | 6745 S Siwell Rd Suite 106 Byram, MS - 392728700 |
Business Phone Number: | 6013730354 |
Business Fax Number: | 6013730321 |
Mailing Address: | 6745 S Siwell Rd, Suite 106 BYRAM |
State: | MS |
Postal Code: | 392728700 |
Phone Number: | 6013730354 |
Fax Number: | 6013730321 |
NPI Enumeration Date: | 02/17/2007 |
NPI Last Update Date: | 02/17/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 152WC0802X |
License Number: | 568 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MS |
Taxonomy Type: | Eye and Vision Services Providers |
Taxonomy Classification: | Optometrist |
Taxonomy Specialization: | Corneal and Contact Management |
Taxonomy Definition: | The professional activities performed by an Optometrist related to the fitting of contact lenses to an eye, ongoing evaluation of the cornea |