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NPI Code Detail

MEDICARE: DR. JUSTIN WILKINSON OD

MEDICARE:  DR. JUSTIN  WILKINSON  OD
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
1152W00000XOptometrist2009010664MO

Other Identifiers

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

General Provider Information

NPI Number : 1821251422
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JUSTIN WILKINSON OD
Provider Business Mailing Address
First Line : 40 E NORTH ST
Second Line :
City : EUREKA
State : MO
Zip : 63025-1205
Country : US
Telephone Number : 636-200-4393
Fax Number : 636-938-2650
Provider Business Practice Location Address
First Line : 8658 BIG BEND BLVD
Second Line :
City : WEBSTER GROVES
State : MO
Zip : 63119-3839
Country : US
Telephone Number : 314-968-4243
Fax Number : 314-968-3273
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/03/2008
Last Update Date : 11/18/2014

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Directions to “ DR. JUSTIN WILKINSON OD” Practice Location

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