Individual
DOUGLAS M WIKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
2023 W MCDERMOTT DR STE 290, ALLEN, TX 75013-4678
(972) 649-4441
Mailing address
2023 W MCDERMOTT DR STE 290, ALLEN, TX 75013-4678
(972) 649-4441
(972) 649-4410
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
5285TG
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
019228802
—
TX
01
—
P00274868
MEDICARE RAILROAD PTAN
TX
Enumeration date
10/22/2007
Last updated
12/07/2023
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