Basic Information
| Provider Information | |||||||||
| NPI: | 1932125093 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WILKINS | ||||||||
| FirstName: | JAY | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 240 CORPORATE DRIVE | ||||||||
| Address2: | |||||||||
| City: | BEAVER DAM | ||||||||
| State: | WI | ||||||||
| PostalCode: | 539163115 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9208871151 | ||||||||
| FaxNumber: | 9208873353 | ||||||||
| Practice Location | |||||||||
| Address1: | 240 CORPORATE DRIVE | ||||||||
| Address2: | |||||||||
| City: | BEAVER DAM | ||||||||
| State: | WI | ||||||||
| PostalCode: | 539163115 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9208871151 | ||||||||
| FaxNumber: | 9208873353 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2006 | ||||||||
| LastUpdateDate: | 04/21/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 04/21/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | 46586 | WI | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | 39115615618 | 01 | UNITY HMO | OTHER | 13792 | 01 | DEAN CARE HMO | OTHER | 3457900 | 05 | WI | MEDICAID | 46250 | 01 | WI | NETWORK HEALTH PLAN | OTHER | WI0120 | 01 | JOHN DEERE HEALTH PLAN | OTHER | 2001237 | 01 | WI | PHYSICIANS PLUS HMO | OTHER | 391156156 | 01 | TAX ID | OTHER | P00134868 | 01 | WI | RAIL ROAD MEDICARE | OTHER |