Provider Demographics
NPI:1366762288
Name:WILSON, ABRAHAM JAMES (OD)
Entity type:Individual
Prefix:DR
First Name:ABRAHAM
Middle Name:JAMES
Last Name:WILSON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:2770 WOODGATE RD
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81401-5466
Mailing Address - Country:US
Mailing Address - Phone:970-249-2330
Mailing Address - Fax:970-249-6131
Practice Address - Street 1:2770 WOODGATE RD
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-5466
Practice Address - Country:US
Practice Address - Phone:970-249-2330
Practice Address - Fax:970-249-6131
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-02
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOPT-2793152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist