Provider Demographics
NPI:1699770206
Name:WILKINS, EDMUND L (MD)
Entity type:Individual
Prefix:
First Name:EDMUND
Middle Name:L
Last Name:WILKINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1724 ROCKINGHAM AVE
Mailing Address - Street 2:STE 201
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104-5841
Mailing Address - Country:US
Mailing Address - Phone:270-745-0040
Mailing Address - Fax:270-745-0041
Practice Address - Street 1:1724 ROCKINGHAM AVE
Practice Address - Street 2:STE 201
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-5841
Practice Address - Country:US
Practice Address - Phone:270-745-0040
Practice Address - Fax:270-745-0041
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY18148207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000049570OtherANTHEM PIN NUMBER
KY64181480Medicaid
KY000000059919OtherANTHEM PROVIDER ID NUMBER
KYC72042Medicare UPIN
KY64181480Medicaid