Provider Demographics
NPI:1215007836
Name:WILKINSON VISION, INC
Entity Type:Organization
Organization Name:WILKINSON VISION, INC
Other - Org Name:VISION SOURCE OF HOT SPRINGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DALLAS
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:WILKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:605-745-3175
Mailing Address - Street 1:200 S CHICAGO ST
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:SD
Mailing Address - Zip Code:57747-2322
Mailing Address - Country:US
Mailing Address - Phone:605-745-3175
Mailing Address - Fax:605-745-4006
Practice Address - Street 1:200 S CHICAGO ST
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:SD
Practice Address - Zip Code:57747-2322
Practice Address - Country:US
Practice Address - Phone:605-745-3175
Practice Address - Fax:605-745-4006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD575152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD9176451OtherDAKOTACARE
SD0007616OtherWELLMARK BCBS
SD9200700Medicaid
SD1447414461OtherWELLMARK BCBS
SDCB3670Medicare PIN
SD1447414461OtherWELLMARK BCBS
SD0007616OtherWELLMARK BCBS
SD4145740001Medicare NSC