Provider Demographics
NPI:1770631038
Name:WILSON, EMMYLOU TERESA HOEFT (OD)
Entity Type:Individual
Prefix:
First Name:EMMYLOU
Middle Name:TERESA HOEFT
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 1:1 W TOWNE MALL
Mailing Address - Street 2:LENSCRAFTERS
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719-1019
Mailing Address - Country:US
Mailing Address - Phone:608-829-2440
Mailing Address - Fax:
Practice Address - Street 1:1 W TOWNE MALL
Practice Address - Street 2:LENSCRAFTERS
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-1019
Practice Address - Country:US
Practice Address - Phone:608-829-2440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3107-035152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist