Provider Demographics
NPI:1326101148
Name:HOUCK, JON WILKINS (OD)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:WILKINS
Last Name:HOUCK
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 1:3728 S 116TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-4635
Mailing Address - Country:US
Mailing Address - Phone:402-697-8966
Mailing Address - Fax:
Practice Address - Street 1:2420 S 73RD ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-2396
Practice Address - Country:US
Practice Address - Phone:402-397-1654
Practice Address - Fax:402-397-7926
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046-009604152W00000X
NE1274152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist