Provider Demographics
NPI:1366538589
Name:WILSON, HELEN R (OD)
Entity type:Individual
Prefix:
First Name:HELEN
Middle Name:R
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 1:3722 S NEWPORT WAY
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-1244
Mailing Address - Country:US
Mailing Address - Phone:303-756-7514
Mailing Address - Fax:
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
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOPT986152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO08998692Medicaid
CO202414294OtherTAX ID
CO202414294OtherTAX ID
CO08998692Medicaid