Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 5793 | CA |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 5793 | CA |
N | 152WL0500X | Optomitrist - Low Vision Rehabilitation | 5793 | CA |
N | 152WP0200X | Pediatric Optomitrist | 5793 | CA |
N | 152WS0006X | Sports Vision | 5793 | CA |
N | 152WV0400X | Optomitrist - Vision Therapist | 5793 | CA |
N | 152WX0102X | Occupational Vision | 5793 | CA |
NPI | 1013247246 |
---|---|
Provider Name | Dr. Paul James Wilson |
First Address | Temecula, CA 92590-3541 |
Second Address | Temecula, CA 92590-3541 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2010 |
Last Update Date | 11/01/2010 |