MEDICARE: DR. ERIN REBECCA WILKENS O.D.

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	02271	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	275782	OTHER	IA	COVENTRY
2	08836	OTHER	IA	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1629035290
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERIN REBECCA WILKENS O.D.

Provider Business Mailing Address
First Line	:	1551 VALLEY WEST DR
Second Line	:	STE. 118B
City	:	WEST DES MOINES
State	:	IA
Zip	:	50266-1112
Country	:	US
Telephone Number	:	515-223-5599
Fax Number	:

Provider Business Practice Location Address
First Line	:	1551 VALLEY WEST DR
Second Line	:	STE. 118B
City	:	WEST DES MOINES
State	:	IA
Zip	:	50266-1112
Country	:	US
Telephone Number	:	515-223-5599
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/27/2006
Last Update Date	:	07/08/2007

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