Provider Demographics
NPI:1265444111
Name:WILKEN, STEPHANIE (OD)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:
Last Name:WILKEN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:755 N DENTON TAP RD
Mailing Address - Street 2:#100
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-2120
Mailing Address - Country:US
Mailing Address - Phone:972-459-3300
Mailing Address - Fax:972-459-0200
Practice Address - Street 1:755 N DENTON TAP RD
Practice Address - Street 2:#100
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-2120
Practice Address - Country:US
Practice Address - Phone:972-459-3300
Practice Address - Fax:972-459-0200
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5763T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX81322QOtherBCBS OF TEXAS
TXU77174Medicare UPIN
TX8A7473Medicare PIN