Doctor Name: | DR. CHARLES ROMEO WILDER |
NPI Number: | 1275562118 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | O.D.,F.A.A.O. |
License Number: | 4901002266 |
Business Practice Address: | 15401 Harriet St Romulus, MI - 481743069 |
Business Phone Number: | 7347827200 |
Business Fax Number: | 7342299558 |
Mailing Address: | 15401 Harriet St, ROMULUS |
State: | MI |
Postal Code: | 481743069 |
Phone Number: | 7347827200 |
Fax Number: | 7342299558 |
NPI Enumeration Date: | 07/02/2006 |
NPI Last Update Date: | 07/09/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 152WC0802X |
License Number: | 4901002266 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
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 |