Provider Demographics
NPI:1992873020
Name:WILDER, CLARE L (OD)
Entity type:Individual
Prefix:DR
First Name:CLARE
Middle Name:L
Last Name:WILDER
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 1:27250 PERDIDO BEACH BLVD UNIT C
Mailing Address - Street 2:
Mailing Address - City:ORANGE BEACH
Mailing Address - State:AL
Mailing Address - Zip Code:36561-3205
Mailing Address - Country:US
Mailing Address - Phone:251-974-1233
Mailing Address - Fax:844-965-9875
Practice Address - Street 1:27250 PERDIDO BEACH BLVD UNIT C
Practice Address - Street 2:
Practice Address - City:ORANGE BEACH
Practice Address - State:AL
Practice Address - Zip Code:36561-3205
Practice Address - Country:US
Practice Address - Phone:251-974-1233
Practice Address - Fax:844-965-9875
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS-988-TA-573152W00000X
FLOPC 3600152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U89138Medicare UPIN
U3091YMedicare PIN
FLU89138Medicare UPIN
FLU3091Medicare ID - Type Unspecified