Wow Vision PC

Primary specialty

OptometristTaxonomy code 152W00000X

License

046009127 Issued in IL

Legal business name

WOW VISION PC

Practice address

7451 Woodward Ave
Suite 101
Woodridge, IL 60517-2665

Phone

(630) 663-9112

Fax

(630) 663-9228

NPI assigned

Dec 28, 2009

Organization subpart

No

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

Authorized official

Name

Dr. Mark D Wilmoth, ODNPI 1912965823

Title

President and Ceo

Phone

(630) 663-9112

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mark D Wilmoth, O.D.

  • Optometrist
  • Woodridge, IL
  • NPI 1912965823
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1261958400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1357084800000",
    "number": "1104156009",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7451 WOODWARD AVE",
            "address_2": "SUITE 101",
            "city": "WOODRIDGE",
            "state": "IL",
            "postal_code": "605172665",
            "telephone_number": "630-663-9112",
            "fax_number": "630-663-9228"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7451 WOODWARD AVE",
            "address_2": "SUITE 101",
            "city": "WOODRIDGE",
            "state": "IL",
            "postal_code": "605172665",
            "telephone_number": "630-663-9112",
            "fax_number": "630-663-9228"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WOW VISION PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-12-28",
        "last_updated": "2013-01-02",
        "status": "A",
        "authorized_official_last_name": "WILMOTH",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PRESIDENT AND CEO",
        "authorized_official_telephone_number": "630-663-9112",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046009127",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Woodridge Family Dental, LLC
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• Shay Woods
• Woodward Comprehensive Medical
• Woodward Medical Center, LTD
• Steffianna Wyatt, RN
• Courtney Wyeth, RN
• Santina Yacoub
• Radostina L Yakimova, LCPC
• Unbreen Yasin, O.D.

• Optometrist in Woodridge, IL
• Providers in Woodridge, IL by specialty
• Optometrist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.