Provider Demographics
NPI:1316140387
Name:WILKEN EYE ASSOCIATES, P.A.
Entity type:Organization
Organization Name:WILKEN EYE ASSOCIATES, P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRET
Authorized Official - Middle Name:E
Authorized Official - Last Name:WILKEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:972-410-1313
Mailing Address - Street 1:651 N DENTON TAP RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-2007
Mailing Address - Country:US
Mailing Address - Phone:972-410-1313
Mailing Address - Fax:972-899-0662
Practice Address - Street 1:651 N DENTON TAP RD
Practice Address - Street 2:SUITE 150
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-2007
Practice Address - Country:US
Practice Address - Phone:972-410-1313
Practice Address - Fax:972-899-0662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-07
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX008OFFOtherBLUE CROSS BLUE SHIELD
TX00263VMedicare PIN