Provider Demographics
NPI:1306097712
Name:WILKINS, JEFFREY SCOTT (ABOM)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:SCOTT
Last Name:WILKINS
Suffix:
Gender:M
Credentials:ABOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 MCCRAVY DR
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29303-3178
Mailing Address - Country:US
Mailing Address - Phone:864-585-2249
Mailing Address - Fax:864-585-3020
Practice Address - Street 1:404 MCCRAVY DR
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-3178
Practice Address - Country:US
Practice Address - Phone:864-585-2249
Practice Address - Fax:864-585-3020
Is Sole Proprietor?:No
Enumeration Date:2008-10-03
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC583156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician