Provider Demographics
NPI:1093233843
Name:WILSON, ALEAH ROSE (OD)
Entity Type:Individual
Prefix:
First Name:ALEAH
Middle Name:ROSE
Last Name:WILSON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 MILL ST
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:PA
Mailing Address - Zip Code:19007-4809
Mailing Address - Country:US
Mailing Address - Phone:215-781-6793
Mailing Address - Fax:215-781-6794
Practice Address - Street 1:216 MILL ST
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:PA
Practice Address - Zip Code:19007-4809
Practice Address - Country:US
Practice Address - Phone:215-781-2020
Practice Address - Fax:215-788-3504
Is Sole Proprietor?:No
Enumeration Date:2017-08-31
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG003336152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist