Provider Demographics
NPI:1225135320
Name:WILKINSON, TOM W
Entity Type:Individual
Prefix:MR
First Name:TOM
Middle Name:W
Last Name:WILKINSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 N PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73107-6412
Mailing Address - Country:US
Mailing Address - Phone:405-236-3838
Mailing Address - Fax:405-236-5001
Practice Address - Street 1:1010 N PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73107-6412
Practice Address - Country:US
Practice Address - Phone:405-236-3838
Practice Address - Fax:405-236-5001
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK0728210001Medicare ID - Type UnspecifiedACTION OPTICAL, INC.