| Organization Name: | ROGER L. WILSON, O.D., P.A. |
| NPI Number: | 1164699054 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ROGER L. WILSON (PRESIDENT) |
| Mailing Address: | 110 Solana Rd Ponte Vedra Beach |
| State: | FL US |
| Postal Code: | 320822230 |
| Phone Number: | 9042802021 |
| Fax Number: | 9042802024 |
| NPI Enumeration Date: | 05/11/2008 |
| NPI Last Update Date: | 05/11/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 152WC0802X |
| License Number: | OP2569 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| 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 |