Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician |
NPI | 1225135320 |
---|---|
Provider Name | Mr. Tom W. Wilkinson |
First Address | Oklahoma City, OK 73107-6412 |
Second Address | Oklahoma City, OK 73107-6412 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 09/07/2007 |