MEDICARE: DR. DAVID CHARLES WILKES 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
1	152W00000X	Optometrist	006161	NY

General Provider Information

NPI Number	:	1609885110
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID CHARLES WILKES O.D.

Provider Business Mailing Address
First Line	:	55 MAIN ST
Second Line	:
City	:	AKRON
State	:	NY
Zip	:	14001
Country	:	US
Telephone Number	:	716-542-2002
Fax Number	:	716-542-6878

Provider Business Practice Location Address
First Line	:	55 MAIN ST
Second Line	:
City	:	AKRON
State	:	NY
Zip	:	14001-1239
Country	:	US
Telephone Number	:	716-542-2002
Fax Number	:	716-542-6878

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

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	05/04/2016

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