Provider Demographics
NPI:1437365665
Name:WILSON KO, M.D., F.A.C.S., P.C.
Entity Type:Organization
Organization Name:WILSON KO, M.D., F.A.C.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILSON
Authorized Official - Middle Name:
Authorized Official - Last Name:KO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-961-3937
Mailing Address - Street 1:13625 MAPLE AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-3870
Mailing Address - Country:US
Mailing Address - Phone:718-358-5900
Mailing Address - Fax:718-463-8049
Practice Address - Street 1:13625 MAPLE AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-3870
Practice Address - Country:US
Practice Address - Phone:718-358-5900
Practice Address - Fax:718-463-8049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery