Healthcare Provider Details

I. General information

NPI: 1780849331
Provider Name (Legal Business Name): GEOFFREY OWEN WILKES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2008
Last Update Date: 09/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 N 87TH ST THE EYE INSTITUTE
MILWAUKEE WI
53226-4812
US

IV. Provider business mailing address

925 N 87TH ST THE EYE INSTITUTE
MILWAUKEE WI
53226-4812
US

V. Phone/Fax

Practice location:
  • Phone: 414-955-2020
  • Fax: 414-955-6300
Mailing address:
  • Phone: 414-955-2020
  • Fax: 414-955-6300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberA112358
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number60611
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: