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General NPI Number Information
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NPI Number | 1255317202
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Entity Type | Individual
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Provider Name | STEPHEN MARK WILKES OD
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Gender | Male
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Dates
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Enumeration Date | 12/21/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2744 S BUCKNER BLVD
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City | DALLAS
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State | TX
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Zip | 75227-6903
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Country | US
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Telephone | 214-388-9767
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Fax | 214-388-4753
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Provider Business Mailing Address
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Address Line | 2002 MERRIMAC TRL
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City | GARLAND
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State | TX
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Zip | 75043-1235
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Country | US
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Telephone | 972-840-0822
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Fax | 214-388-4753
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 3238TG
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License Number State | TX
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