Provider Demographics
NPI:1386805273
Name:WILKINS, JUSTIN C (OD)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:C
Last Name:WILKINS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:KY
Mailing Address - Zip Code:42134-1331
Mailing Address - Country:US
Mailing Address - Phone:270-776-2020
Mailing Address - Fax:270-598-2020
Practice Address - Street 1:705 N MAIN ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:KY
Practice Address - Zip Code:42134-1331
Practice Address - Country:US
Practice Address - Phone:270-776-2020
Practice Address - Fax:270-598-2020
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-23
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1734DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100057040Medicaid
KY1973301Medicare Oscar/Certification
KYK198330Medicare PIN