Provider Demographics
NPI:1629035290
Name:WILKENS, ERIN REBECCA (OD)
Entity Type:Individual
Prefix:DR
First Name:ERIN
Middle Name:REBECCA
Last Name:WILKENS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:ERIN
Other - Middle Name:REBECCA
Other - Last Name:PETERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1551 VALLEY WEST DR
Mailing Address - Street 2:STE. 118B
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-1112
Mailing Address - Country:US
Mailing Address - Phone:515-223-5599
Mailing Address - Fax:
Practice Address - Street 1:1551 VALLEY WEST DR
Practice Address - Street 2:STE. 118B
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-1112
Practice Address - Country:US
Practice Address - Phone:515-223-5599
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02271152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA275782OtherCOVENTRY
IA08836OtherBLUE CROSS BLUE SHIELD
IAI17289Medicare ID - Type Unspecified
IAV08843Medicare UPIN