Michael Lyle Wilson PC

Primary specialty

OptometristTaxonomy code 152W00000X

License

02482 Issued in MI

Legal business name

MICHAEL LYLE WILSON PC

Practice address

101 Walnut St
Manistique, MI 49854-1435

Phone

(906) 341-5689

Fax

(906) 341-5723

NPI assigned

Mar 28, 2008

Last updated

Feb 21, 2013By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Marie Bellville

Title

Assistant

Phone

(906) 341-5689

Specialties & licenses 2

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1206662400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1361404800000",
    "number": "1427220508",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 WALNUT ST",
            "city": "MANISTIQUE",
            "state": "MI",
            "postal_code": "498541435"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 WALNUT ST",
            "city": "MANISTIQUE",
            "state": "MI",
            "postal_code": "498541435",
            "telephone_number": "906-341-5689",
            "fax_number": "906-341-5723"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHAEL LYLE WILSON PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-28",
        "last_updated": "2013-02-21",
        "status": "A",
        "authorized_official_last_name": "BELLVILLE",
        "authorized_official_first_name": "MARIE",
        "authorized_official_title_or_position": "ASSISTANT",
        "authorized_official_telephone_number": "906-341-5689"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "MI",
            "license": "02482",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MI",
            "license": "02482",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Optometrist in Manistique, MI
• Providers in Manistique, MI by specialty
• Optometrist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.