Provider Demographics
NPI:1649395245
Name:WILKINSON, DENISE (OD)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:WILKINSON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1277 NE BIRKSHIRE CT
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-2028
Mailing Address - Country:US
Mailing Address - Phone:971-645-7330
Mailing Address - Fax:
Practice Address - Street 1:18070 NW EVERGREEN PKWY
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-7451
Practice Address - Country:US
Practice Address - Phone:503-617-0862
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3199ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist