Provider Demographics
NPI:1023502879
Name:WOLKE, TAYLOR MARIE (OD)
Entity type:Individual
Prefix:DR
First Name:TAYLOR
Middle Name:MARIE
Last Name:WOLKE
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 1:1924 WOODSTONE LN
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:MN
Mailing Address - Zip Code:55386-9638
Mailing Address - Country:US
Mailing Address - Phone:651-470-4310
Mailing Address - Fax:
Practice Address - Street 1:8617 W POINT DOUGLAS RD S STE 110
Practice Address - Street 2:
Practice Address - City:COTTAGE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55016-4122
Practice Address - Country:US
Practice Address - Phone:651-769-1020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-15
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3568152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist