Provider Demographics
NPI:1508035346
Name:LEONARD L. WILKINS O.D.
Entity Type:Organization
Organization Name:LEONARD L. WILKINS O.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:WILKINS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:918-456-0585
Mailing Address - Street 1:209 WOODLAWN AVE
Mailing Address - Street 2:
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74464-3317
Mailing Address - Country:US
Mailing Address - Phone:918-456-0585
Mailing Address - Fax:918-456-6232
Practice Address - Street 1:209 WOODLAWN AVE
Practice Address - Street 2:
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464-3317
Practice Address - Country:US
Practice Address - Phone:918-456-0585
Practice Address - Fax:918-456-6232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-26
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKOK0815152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK0676100001Medicare PIN
OK0676100001Medicare NSC