Provider Demographics
NPI:1932105178
Name:WILCOXON, DENNIS EMERY (OD)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:EMERY
Last Name:WILCOXON
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 1:1950 OLD GALLOWS RD STE 520
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3970
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:571-223-6780
Practice Address - Street 1:2643 GULF TO BAY BLVD STE 1520
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33759
Practice Address - Country:US
Practice Address - Phone:727-799-3937
Practice Address - Fax:727-210-1189
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-22
Last Update Date:2019-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 2255152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL410039521OtherRAIL ROAD MEDICARE
FL078875900Medicaid
FL1266230001Medicare NSC
FL410039521OtherRAIL ROAD MEDICARE
FL078875900Medicaid