Provider Demographics
NPI:1518164995
Name:WILKES, MARTIN F (MD)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:F
Last Name:WILKES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89 SYLVANIA DR FL 2
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45440-3282
Mailing Address - Country:US
Mailing Address - Phone:937-427-8900
Mailing Address - Fax:937-427-1710
Practice Address - Street 1:89 SYLVANIA DR FL 2
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45440
Practice Address - Country:US
Practice Address - Phone:937-427-8900
Practice Address - Fax:937-427-1710
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35097206207WX0107X
OH35.097206207W00000X, 207W00000X
VA0116019406390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3151048Medicaid
OH000000708542OtherBCBS/ANTHEM
GA202I181794OtherMEDICARE PTAN
OH3151048Medicaid