Provider Demographics
NPI:1417938721
Name:WILSON OPTICAL & HEARING CENTRE, INC.
Entity Type:Organization
Organization Name:WILSON OPTICAL & HEARING CENTRE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-345-8076
Mailing Address - Street 1:114 E LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-4346
Mailing Address - Country:US
Mailing Address - Phone:330-345-8076
Mailing Address - Fax:330-345-7276
Practice Address - Street 1:114 E LIBERTY ST
Practice Address - Street 2:
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-4346
Practice Address - Country:US
Practice Address - Phone:330-345-8076
Practice Address - Fax:330-345-7276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-14
Last Update Date:2011-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS. 306156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0940003Medicaid
OH9292184Medicare PIN