Provider Demographics
NPI:1538423769
Name:WILKINS, MARK ALAN (OD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:ALAN
Last Name:WILKINS
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:402 LYNWOOD FOREST DR
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:MO
Mailing Address - Zip Code:63021-5511
Mailing Address - Country:US
Mailing Address - Phone:314-860-2020
Mailing Address - Fax:314-860-2020
Practice Address - Street 1:2021 MAPLEWOOD COMMONS DR
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MO
Practice Address - Zip Code:63143-1003
Practice Address - Country:US
Practice Address - Phone:314-860-2020
Practice Address - Fax:314-860-2020
Is Sole Proprietor?:No
Enumeration Date:2012-07-03
Last Update Date:2025-12-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2012017715152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist