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General NPI Number Information
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NPI Number | 1689765414
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Entity Type | Organization
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Legal Business Name | LARRY WILKINSON
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Dates
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Enumeration Date | 09/27/2006
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Last Update Date | 06/26/2015
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Provider Practice Location Address
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Address Line | 4000 AVENUE I
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City | ROSENBERG
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State | TX
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Zip | 77471-3904
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Country | US
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Telephone | 281-342-4664
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Fax | 281-232-0894
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Provider Business Mailing Address
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Address Line | 4000 AVENUE I P O BOX 607
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City | ROSENBERG
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State | TX
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Zip | 77471-3904
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Country | US
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Telephone | 281-342-4664
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Fax | 281-232-0894
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Authorized Official
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Title or Position | OWNER / OPTOMETRIST
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Name | DR. LARRY (NMI) WILKINSON
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Credential | O. D.
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Telephone | 281-342-4664
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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 | 02165T
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License Number State | TX
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