Active NPI
Wayne Hudson
- Optometrist
- Douglas, WY
National Provider Identifier
1023067915
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 128T
- Practice address
- 124 N 4TH St
Douglas, WY 82633-2402 - Phone
- (307) 358-9008
- Fax
- (307) 358-5183
- NPI assigned
- May 8, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 128T | WY | Primary |
Addresses
Primary practice location
124 N 4TH St
Douglas, WY 82633-2402
Mailing address
124 N 4TH St
Douglas, WY 82633-2402
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 114737400 | Medicaid | WY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WY
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20120116000085 | WY | Practitioner - Optometry | 6507983764 | Practice locations: Douglas, WY |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 128T | WY | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147046400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1282867200000",
"number": "1023067915",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "124 N 4TH ST",
"city": "DOUGLAS",
"state": "WY",
"postal_code": "826332402"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "124 N 4TH ST",
"city": "DOUGLAS",
"state": "WY",
"postal_code": "826332402",
"telephone_number": "307-358-9008",
"fax_number": "307-358-5183"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HUDSON",
"first_name": "WAYNE",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-05-08",
"last_updated": "2010-08-27",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "WY",
"license": "128T",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "114737400",
"state": "WY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Douglas, WY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.