Active NPI
Stacey L. Wilda, O.D., P.C.
- Optometrist
- Perry, OK
National Provider Identifier
1003935487
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 2236
- Legal business name
- STACEY L. WILDA, O.D., P.C.
- Practice address
- 415 N 7TH St
Perry, OK 73077-6407 - Phone
- (580) 336-0777
- Fax
- (580) 336-0888
- NPI assigned
- Mar 28, 2007
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Stacey Lyn Wilda, O.D.
- Title
- President Owner Optometrist
- Phone
- (580) 336-0777
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 2236 | OK | Primary |
Addresses
Primary practice location
415 N 7TH St
Perry, OK 73077-6407
Mailing address
415 N 7TH St
Perry, OK 73077-6407
Phone (580) 336-0777
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OK
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050505000106 | OK | Part B Supplier - Clinic/Group Practice | 0941240345 |
Receives reassigned benefits from 2 practitioners Practice locations: Perry, OK |
National Provider Directory
National Provider DirectoryLocations
415 N 7th St
Perry, OK 73077
Phone (580) 336-0777
Practitioners & affiliated clinicians
Practitioners 2
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175040000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1228694400000",
"number": "1003935487",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "415 N 7TH ST",
"city": "PERRY",
"state": "OK",
"postal_code": "730776407",
"telephone_number": "580-336-0777",
"fax_number": "580-336-0888"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "415 N 7TH ST",
"city": "PERRY",
"state": "OK",
"postal_code": "730776407",
"telephone_number": "580-336-0777",
"fax_number": "580-336-0888"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "STACEY L. WILDA, O.D., P.C.",
"organizational_subpart": "NO",
"enumeration_date": "2007-03-28",
"last_updated": "2008-12-08",
"status": "A",
"authorized_official_last_name": "WILDA",
"authorized_official_first_name": "STACEY",
"authorized_official_middle_name": "LYN",
"authorized_official_title_or_position": "PRESIDENT OWNER OPTOMETRIST",
"authorized_official_telephone_number": "580-336-0777",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "O.D."
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Optometrist",
"state": "OK",
"license": "2236",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Perry, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.