=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538423769
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARK ALAN WILKINS O.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/03/2012
-----------------------------------------------------
Last Update Date | 12/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2021 MAPLEWOOD COMMONS DR
-----------------------------------------------------
City | MAPLEWOOD
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63143-1003
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-860-2020
-----------------------------------------------------
Fax | 314-860-2020
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 402 LYNWOOD FOREST DR
-----------------------------------------------------
City | MANCHESTER
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63021-5511
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-860-2020
-----------------------------------------------------
Fax | 314-860-2020
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 2012017715
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------