Provider Demographics
NPI:1649289489
Name:WILSON, STEPHANIE ANN (OD)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:ANN
Last Name:WILSON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MS
Other - First Name:STEPHANIE
Other - Middle Name:ANN
Other - Last Name:HOELSCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:4311 W. WADLEY AVE.
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79707-5457
Mailing Address - Country:US
Mailing Address - Phone:432-689-0323
Mailing Address - Fax:432-689-2916
Practice Address - Street 1:4311 W. WADLEY AVE.
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79707-5457
Practice Address - Country:US
Practice Address - Phone:432-689-0323
Practice Address - Fax:432-689-2916
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6715TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist