Provider Demographics
NPI:1891748232
Name:WILKINS, JEFFREY SCOTT (OD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:SCOTT
Last Name:WILKINS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:476 SHOTWELL RD STE 104
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27520-3506
Mailing Address - Country:US
Mailing Address - Phone:919-553-8181
Mailing Address - Fax:919-359-1504
Practice Address - Street 1:476 SHOTWELL RD STE 104
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27520-3506
Practice Address - Country:US
Practice Address - Phone:919-553-8181
Practice Address - Fax:919-359-1504
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1972152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89093RVMedicaid
NC093RVOtherBCBSNC PIN
NC2473507DOtherMEDICARE PROVIDER NUMBER
NC093RVOtherBCBSNC PIN
NC2473507DOtherMEDICARE PROVIDER NUMBER