Provider Demographics
NPI:1386615961
Name:WILDER, JAMES DANIEL III (OD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:DANIEL
Last Name:WILDER
Suffix:III
Gender:M
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:PO BOX 2020
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36533-2020
Mailing Address - Country:US
Mailing Address - Phone:251-990-3937
Mailing Address - Fax:251-990-9990
Practice Address - Street 1:411 N SECTION ST
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-2634
Practice Address - Country:US
Practice Address - Phone:251-990-3937
Practice Address - Fax:251-990-9990
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS-B26-TA-699152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALWI009911416Medicaid
ALP00270672Medicare PIN
ALV02244Medicare UPIN
AL56934Medicare PIN