Provider Demographics
NPI:1730231176
Name:HELEN R WILSON OD PC
Entity type:Organization
Organization Name:HELEN R WILSON OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:303-754-0122
Mailing Address - Street 1:9220 KIMMER DR
Mailing Address - Street 2:# 140
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-2878
Mailing Address - Country:US
Mailing Address - Phone:303-754-0122
Mailing Address - Fax:303-754-3176
Practice Address - Street 1:9220 KIMMER DR
Practice Address - Street 2:#140
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-2878
Practice Address - Country:US
Practice Address - Phone:303-754-0122
Practice Address - Fax:303-754-3176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOPT986152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO61131075Medicaid
CO=========OtherTAX ID
CO=========OtherTAX ID
CODU0406Medicare PIN