Individual provider Active NPI

Amy Wilson, OD

  • Optometrist
  • Tulsa, OK
National Provider Identifier
1023290863
Registry record updated Jan 19, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2380 Issued in OK
Practice address
7466 S Olympia Ave W
Tulsa, OK 74132-1838
Phone
(918) 447-0080
Fax
(918) 447-0088
NPI assigned
Dec 4, 2007
Last updated
Jan 19, 2016By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 19, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 2380 OK Primary

Addresses

Primary practice location

7466 S Olympia Ave W
Tulsa, OK 74132-1838

Mailing address

7466 S Olympia Ave W
Tulsa, OK 74132-1838
Phone (918) 447-0080

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120229000459 OK Practitioner - Optometry 0840458345 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2380OKMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Riverside Eye Clinic Optometrist Past Accepting new patients
Tulsa Hills Eye Associates PLLC Optometrist Past Accepting new patients
Riverside Eye Clinic Optometrist Past Accepting new patients
Rose Rock Eyecare PLLC Optometrist PastSince Aug 2, 2022 Accepting new patients

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1196726400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1453161600000",
    "number": "1023290863",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7466 S OLYMPIA AVE W",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741321838",
            "telephone_number": "918-447-0080",
            "fax_number": "918-447-0088"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7466 S OLYMPIA AVE W",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741321838",
            "telephone_number": "918-447-0080",
            "fax_number": "918-447-0088"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "AMY",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-12-04",
        "last_updated": "2016-01-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OK",
            "license": "2380",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tulsa, OK

Sources for this page

Verify at the official NPI Registry.