Active NPI
Phillip Lee Wilson, AUD CCCA
- Audiologist-Hearing Aid Fitter
- Dallas, TX
National Provider Identifier
1053493155
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Audiologist-Hearing Aid Fitter
- License
- 90336
- Practice address
- 1966 Inwood Rd
Dallas, TX 75235-7298 - Phone
- (214) 905-3010
- Fax
- (214) 905-3022
- NPI assigned
- Oct 19, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Audiologist | 231H00000X | 50319 | TX | |
| Audiologist-Hearing Aid Fitter | 237600000X | 90336 | Primary |
Addresses
Primary practice location
1966 Inwood Rd
Dallas, TX 75235-7298
Mailing address
1966 Inwood Rd
Dallas, TX 75235-7298
Phone (214) 905-3010
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 80175A | Other | TX | BLUE CROSS BLUE SHIELD |
| 1585769 | Medicaid | LA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 50319 | TX | MD | Audiologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161216000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1757548800000",
"number": "1053493155",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1966 INWOOD RD",
"city": "DALLAS",
"state": "TX",
"postal_code": "752357298",
"telephone_number": "214-905-3010",
"fax_number": "214-905-3022"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1966 INWOOD RD",
"city": "DALLAS",
"state": "TX",
"postal_code": "752357298",
"telephone_number": "214-905-3010",
"fax_number": "214-905-3022"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "PHILLIP",
"middle_name": "LEE",
"name_prefix": "Dr.",
"credential": "AUD CCCA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-19",
"last_updated": "2025-09-11",
"status": "A"
},
"taxonomies": [
{
"code": "231H00000X",
"taxonomy_group": "",
"desc": "Audiologist",
"state": "TX",
"license": "50319",
"primary": false
},
{
"code": "237600000X",
"taxonomy_group": "",
"desc": "Audiologist-Hearing Aid Fitter",
"state": null,
"license": "90336",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "80175A",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1585769",
"state": "LA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Dallas, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.