Provider Demographics
NPI:1881601565
Name:WILSON, MAURICE JOE (OD)
Entity type:Individual
Prefix:DR
First Name:MAURICE
Middle Name:JOE
Last Name:WILSON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1409 N LOOP 336 W
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-3503
Mailing Address - Country:US
Mailing Address - Phone:936-788-2551
Mailing Address - Fax:936-788-2551
Practice Address - Street 1:1409 N LOOP 336 W
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-3503
Practice Address - Country:US
Practice Address - Phone:936-788-2551
Practice Address - Fax:936-788-2551
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3708T152WC0802X
CAOPT13434TPA152WC0802X
TX3708TG152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX127225407Medicaid
TX127225407Medicaid
TXT16687Medicare UPIN