Dr Ann L Wild Optometrist PA

Primary specialty

OptometristTaxonomy code 152W00000X

License

2142TG Issued in TX

Legal business name

DR ANN L WILD OPTOMETRIST PA

Doing business as

Dr Ann L Wild, Optometrist

Practice address

2746 Longmire Dr
College Station, TX 77845-5424

Phone

(979) 764-1554

Fax

(979) 694-2259

NPI assigned

Apr 24, 2008

Organization subpart

No

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

Authorized official

Name

Dr. Ann L Wild, OD

Title

Owner

Phone

(979) 764-1554

Specialties & licenses 1

Addresses

Other names 1

• Dr Ann L Wild, Optometrist Doing business as

Locations

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

{
    "created_epoch": "1208995200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208995200000",
    "number": "1063687606",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2746 LONGMIRE DR",
            "city": "COLLEGE STATION",
            "state": "TX",
            "postal_code": "778455424",
            "telephone_number": "979-764-1554",
            "fax_number": "979-694-2259"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2746 LONGMIRE DR",
            "city": "COLLEGE STATION",
            "state": "TX",
            "postal_code": "778455424",
            "telephone_number": "979-764-1554",
            "fax_number": "979-694-2259"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR ANN L WILD OPTOMETRIST PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-24",
        "last_updated": "2008-04-24",
        "status": "A",
        "authorized_official_last_name": "WILD",
        "authorized_official_first_name": "ANN",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "979-764-1554",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "TX",
            "license": "2142TG",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dr Ann L Wild, Optometrist",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Optometrist in College Station, TX
• Providers in College Station, TX by specialty
• Optometrist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.