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NPI Code Detail

MEDICARE: DR. LARRY WILKINSON O. D.

MEDICARE: DR. LARRY WILKINSON O. D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist02165TTX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1093702748
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LARRY WILKINSON O. D.
Provider Business Mailing Address
First Line : 4000 AVENUE I
Second Line : P O BOX 607
City : ROSENBERG
State : TX
Zip : 77471-3904
Country : US
Telephone Number : 281-342-4664
Fax Number : 281-232-0894
Provider Business Practice Location Address
First Line : 4000 AVENUE I
Second Line :
City : ROSENBERG
State : TX
Zip : 77471-3904
Country : US
Telephone Number : 281-342-4664
Fax Number : 281-232-0894
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/28/2005
Last Update Date : 08/21/2013

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