Provider Demographics
NPI:1699888909
Name:WILKEN, BRET EDWARD (OD)
Entity type:Individual
Prefix:DR
First Name:BRET
Middle Name:EDWARD
Last Name:WILKEN
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 1:755 N DENTON TAP RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-2120
Mailing Address - Country:US
Mailing Address - Phone:972-459-3300
Mailing Address - Fax:972-459-0200
Practice Address - Street 1:755 N DENTON TAP RD
Practice Address - Street 2:SUITE 100
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-2120
Practice Address - Country:US
Practice Address - Phone:972-459-3300
Practice Address - Fax:972-459-0200
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5605TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX81321QOtherBCBS PROVIDER NO.
TX81321QOtherBCBS PROVIDER NO.
TXTXB144902Medicare PIN