Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 568 | MS |
NPI | 1093859563 |
---|---|
Provider Name | Dr. Sidney Maurice Wilson |
First Address | Byram, MS 39272-8700 |
Second Address | Byram, MS 39272-8700 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/02/2007 |
Last Update Date | 17/02/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02229351 | (05) | MS |
T85037 | (02) | MS |