Provider Demographics
NPI:1619147535
Name:TIMOTHY ANDREW WILKINS
Entity Type:Organization
Organization Name:TIMOTHY ANDREW WILKINS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:WILKINS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:559-252-2325
Mailing Address - Street 1:2331 KERN ST
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93721-2700
Mailing Address - Country:US
Mailing Address - Phone:559-264-7799
Mailing Address - Fax:
Practice Address - Street 1:2331 KERN ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93721-2700
Practice Address - Country:US
Practice Address - Phone:559-264-7799
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-06
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0056151Medicaid
CA0379460003Medicare NSC
CASD0056152Medicare PIN
CASD0056151Medicaid