Provider Demographics
NPI:1548386907
Name:WILKEMEYER, ROBERT (OD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:WILKEMEYER
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 1:777 N YORK RD
Mailing Address - Street 2:SUITE # 8
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-3559
Mailing Address - Country:US
Mailing Address - Phone:630-323-0523
Mailing Address - Fax:
Practice Address - Street 1:777 N YORK RD
Practice Address - Street 2:SUITE # 8
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-3559
Practice Address - Country:US
Practice Address - Phone:630-323-0523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0046-008055152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILT38434Medicare UPIN