Provider Demographics
NPI:1720268287
Name:WILKINSON AND SHAFFER PC
Entity Type:Organization
Organization Name:WILKINSON AND SHAFFER PC
Other - Org Name:TOTAL FAMILY EYECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CODY
Authorized Official - Middle Name:JOE
Authorized Official - Last Name:WILKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:325-235-2624
Mailing Address - Street 1:1406 HAILEY ST
Mailing Address - Street 2:
Mailing Address - City:SWEETWATER
Mailing Address - State:TX
Mailing Address - Zip Code:79556-2508
Mailing Address - Country:US
Mailing Address - Phone:325-235-2624
Mailing Address - Fax:325-235-8326
Practice Address - Street 1:1406 HAILEY ST
Practice Address - Street 2:
Practice Address - City:SWEETWATER
Practice Address - State:TX
Practice Address - Zip Code:79556-2508
Practice Address - Country:US
Practice Address - Phone:325-235-2624
Practice Address - Fax:325-235-8326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-13
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6473TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5649770001Medicare NSC