Provider Demographics
NPI:1578691515
Name:WILKER, SHAWN C (MD)
Entity Type:Individual
Prefix:MR
First Name:SHAWN
Middle Name:C
Last Name:WILKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:24075 COMMERCE PARK
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5846
Mailing Address - Country:US
Mailing Address - Phone:216-831-5704
Mailing Address - Fax:216-839-4905
Practice Address - Street 1:24075 COMMERCE PARK
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5846
Practice Address - Country:US
Practice Address - Phone:216-831-5704
Practice Address - Fax:216-839-4905
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.093559207W00000X
MDD0065667207W00000X
FLME117170207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00760963OtherMEDICARE RAILROAD
FL010149500Medicaid
OH2956305Medicaid
FL97872Medicare PIN
OH2956305Medicaid
FLHP165ZMedicare Oscar/Certification
FLHP165YMedicare Oscar/Certification