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General NPI Number Information
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NPI Number | 1578639910
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Entity Type | Organization
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Legal Business Name | THOMAS K. WILCOX, O.D. AND ASSOCIATES, P.C.
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Dates
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Enumeration Date | 11/28/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4802 VALLEY VIEW BLVD NW
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City | ROANOKE
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State | VA
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Zip | 24012-2001
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Country | US
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Telephone | 540-563-8279
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Fax | 540-563-5598
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Provider Business Mailing Address
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Address Line | 4802 VALLEY VIEW BLVD NW
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City | ROANOKE
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State | VA
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Zip | 24012-2001
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Country | US
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Telephone | 540-563-8279
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Fax | 540-563-5598
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. THOMAS KENT WILCOX
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Credential | O.D.
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Telephone | 540-563-8279
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 0618000148
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License Number State | VA
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