MEDICARE: WILKINSON VISION, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	575	SD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	9176451	OTHER	SD	DAKOTACARE
2	0007616	OTHER	SD	WELLMARK BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	1447414461	OTHER	SD	WELLMARK BCBS

General Provider Information

NPI Number	:	1215007836
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILKINSON VISION, INC

Provider Business Mailing Address
First Line	:	200 S CHICAGO ST
Second Line	:
City	:	HOT SPRINGS
State	:	SD
Zip	:	57747-2322
Country	:	US
Telephone Number	:	605-745-3175
Fax Number	:	605-745-4006

Provider Business Practice Location Address
First Line	:	200 S CHICAGO ST
Second Line	:
City	:	HOT SPRINGS
State	:	SD
Zip	:	57747-2322
Country	:	US
Telephone Number	:	605-745-3175
Fax Number	:	605-745-4006

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DALLAS CHARLES WILKINSON
Credential	:	O.D.
Telephone Number	:	605-745-3175

Provider Enumeration Date	:	11/09/2006
Last Update Date	:	06/15/2020

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Directions to “WILKINSON VISION, INC ” Practice Location

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