Provider Demographics
NPI:1326020322
Name:WILKINSON, CODY JOE (OD)
Entity Type:Individual
Prefix:DR
First Name:CODY
Middle Name:JOE
Last Name:WILKINSON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1406 HAILEY ST
Mailing Address - Street 2:
Mailing Address - City:SWEETWATER
Mailing Address - State:TX
Mailing Address - Zip Code:79556-2508
Mailing Address - Country:US
Mailing Address - Phone:325-235-2624
Mailing Address - Fax:325-235-8326
Practice Address - Street 1:1406 HAILEY ST
Practice Address - Street 2:
Practice Address - City:SWEETWATER
Practice Address - State:TX
Practice Address - Zip Code:79556-2508
Practice Address - Country:US
Practice Address - Phone:325-235-2624
Practice Address - Fax:325-235-8326
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6473TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX144963100OtherFIRST CARE
TX81335QOtherBLUE CROSS BLUE SHIELD
5649770001Medicare NSC
TXU97213Medicare UPIN
TX8D2129Medicare ID - Type Unspecified