Individual provider Active NPI

Kari Lynn Wilkerson, OD

  • Optometrist
  • Wagoner, OK
National Provider Identifier
1083167027
Registry record updated Mar 17, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2912 Issued in OK
Practice address
1108 W Cherokee St
Wagoner, OK 74467-4622
Phone
(918) 485-2123
Fax
(918) 485-4777
NPI assigned
Jul 26, 2016
Last updated
Mar 17, 2020By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 17, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 2912 OK Primary

Addresses

Primary practice location

1108 W Cherokee St
Wagoner, OK 74467-4622

Mailing address

1108 W Cherokee St
Wagoner, OK 74467-4622
Phone (918) 485-2123

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
I20161215000122 OK Practitioner - Optometry 2668752312 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Terry L Lawson Ms OD PLLCGroup PAC ID 8224194980, 3 clinicians

Practice addresses (Care Compare)

209 Woodlawn Ave
Tahlequah, OK 74464-3317
Phone (918) 822-3696

9102 S Toledo Ave
Suite a
Tulsa, OK 74137-2741
Phone (918) 742-2055

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery20

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2912OKMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Wilkerson Eye Care, PLLC Optometrist CurrentSince Apr 14, 2025 Accepting new patients
MBR Eye LLC Optometrist CurrentSince Jan 1, 2020 Accepting new patients
Advanced Family Eye Care Inc Optometrist PastSince Aug 9, 2007 Accepting new patients

Locations

10557 E Highway 51
Broken Arrow, OK 74014
Phone (918) 279-8830

209 Woodlawn Ave
Tahlequah, OK 74464
Phone (918) 456-0585

1108 W Cherokee St
Wagoner, OK 74467
Phone (918) 279-8830

Organizations & group practices 4

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": "1469491200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1584403200000",
    "number": "1083167027",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1108 W CHEROKEE ST",
            "city": "WAGONER",
            "state": "OK",
            "postal_code": "744674622",
            "telephone_number": "918-485-2123",
            "fax_number": "918-485-4777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1108 W CHEROKEE ST",
            "city": "WAGONER",
            "state": "OK",
            "postal_code": "744674622",
            "telephone_number": "918-485-2123",
            "fax_number": "918-485-4777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILKERSON",
        "first_name": "KARI",
        "middle_name": "LYNN",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-07-26",
        "last_updated": "2020-03-17",
        "certification_date": "2020-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OK",
            "license": "2912",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wagoner, OK

Sources for this page

Verify at the official NPI Registry.