MEDICARE: MR. TOM W. WILKINSON

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
1	156FX1800X	Optician

General Provider Information

NPI Number	:	1225135320
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TOM W. WILKINSON

Provider Business Mailing Address
First Line	:	1010 N PENNSYLVANIA AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73107-6412
Country	:	US
Telephone Number	:	405-236-3838
Fax Number	:	405-236-5001

Provider Business Practice Location Address
First Line	:	1010 N PENNSYLVANIA AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73107-6412
Country	:	US
Telephone Number	:	405-236-3838
Fax Number	:	405-236-5001

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	07/09/2007

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