Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 156FC0800X | Contact Lens | LDO000306 | GA |
N | 156FC0801X | Contact Lens Fitter | LDO000306 | GA |
Y | 156FX1800X | Optician | LDO000306 | GA |
NPI | 1093286726 |
---|---|
Provider Name | Thomas Edward Wilkins |
First Address | Thomaston, GA 30286-2744 |
Second Address | Thomaston, GA 30286-3622 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2018 |
Last Update Date | 06/12/2018 |