Provider Demographics
NPI:1427055516
Name:WILSON, RONALD B
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:B
Last Name:WILSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 PRINCESS RD
Mailing Address - Street 2:STE 202
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-2322
Mailing Address - Country:US
Mailing Address - Phone:609-219-9000
Mailing Address - Fax:609-219-1313
Practice Address - Street 1:4 PRINCESS RD
Practice Address - Street 2:STE 202
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648-2322
Practice Address - Country:US
Practice Address - Phone:609-219-9000
Practice Address - Fax:609-219-1313
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27TOA00294000152W00000X
NJ27TO00039900152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ22-2516468OtherHORIZON
NJ0116010OtherAETNA
0997381005OtherCIGNA
0997381005OtherCIGNA