Healthcare Provider Details

I. General information

NPI: 1609885110
Provider Name (Legal Business Name): DAVID CHARLES WILKES O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 05/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 MAIN ST
AKRON NY
14001-1239
US

IV. Provider business mailing address

55 MAIN ST
AKRON NY
14001
US

V. Phone/Fax

Practice location:
  • Phone: 716-542-2002
  • Fax: 716-542-6878
Mailing address:
  • Phone: 716-542-2002
  • Fax: 716-542-6878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number006161
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: