Provider Demographics
NPI:1861485443
Name:WILES, MOLLY DARA (OD)
Entity Type:Individual
Prefix:DR
First Name:MOLLY
Middle Name:DARA
Last Name:WILES
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:MOLLY
Other - Middle Name:DARA
Other - Last Name:CARREN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1919 OXFORD ST N
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-4954
Mailing Address - Country:US
Mailing Address - Phone:727-272-0449
Mailing Address - Fax:
Practice Address - Street 1:4010 PARK BLVD N
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33781-3633
Practice Address - Country:US
Practice Address - Phone:727-369-4290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-29
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC5635152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist