Provider Demographics
NPI:1285826701
Name:WILSON, MEGAN L (OD)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:L
Last Name:WILSON
Suffix:
Gender:F
Credentials:OD
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Mailing Address - Street 1:5008 CLARK LN
Mailing Address - Street 2:APT #100
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65202
Mailing Address - Country:US
Mailing Address - Phone:573-808-6224
Mailing Address - Fax:573-445-5589
Practice Address - Street 1:2300 BERNADETTE DR
Practice Address - Street 2:COLUMBIA MALL SPACE 700
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-4607
Practice Address - Country:US
Practice Address - Phone:573-445-5448
Practice Address - Fax:573-445-5589
Is Sole Proprietor?:No
Enumeration Date:2007-08-17
Last Update Date:2007-08-17
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Provider Licenses
StateLicense IDTaxonomies
MO2007023594152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist