Provider Demographics
NPI:1992952808
Name:ERIN R WILKENS, O.D., P.C.
Entity type:Organization
Organization Name:ERIN R WILKENS, O.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:R
Authorized Official - Last Name:WILKENS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:515-259-9009
Mailing Address - Street 1:5525 MERLE HAY RD
Mailing Address - Street 2:SUITE 155
Mailing Address - City:JOHNSTON
Mailing Address - State:IA
Mailing Address - Zip Code:50131-1444
Mailing Address - Country:US
Mailing Address - Phone:515-259-9009
Mailing Address - Fax:515-259-9001
Practice Address - Street 1:5525 MERLE HAY RD
Practice Address - Street 2:SUITE 155
Practice Address - City:JOHNSTON
Practice Address - State:IA
Practice Address - Zip Code:50131-1444
Practice Address - Country:US
Practice Address - Phone:515-259-9009
Practice Address - Fax:515-259-9001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-21
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02271152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAV08843Medicare UPIN
IAI17288Medicare PIN