Provider Demographics
NPI:1619539368
Name:WILKINSON, TAYLOR (OD)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:WILKINSON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:
Other - Last Name:MOLLN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:183 N ADDISON AVE APT 327
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-3198
Mailing Address - Country:US
Mailing Address - Phone:815-988-1773
Mailing Address - Fax:
Practice Address - Street 1:62 OAKBROOK CTR
Practice Address - Street 2:
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-1810
Practice Address - Country:US
Practice Address - Phone:224-500-6395
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-02
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046011326152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist