Individual provider Active NPI

Stephen King Wheeler, O.D.

  • Optometrist
  • Xenia, OH
National Provider Identifier
1104832112
Registry record updated Nov 27, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
3006 Issued in OH
Practice address
322 N Detroit St
Xenia, OH 45385-2233
Phone
(937) 376-4055
Fax
(937) 376-3969
NPI assigned
Jul 31, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 27, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 3006 OH Primary

Addresses

Primary practice location

322 N Detroit St
Xenia, OH 45385-2233

Mailing address

322 N Detroit St
Xenia, OH 45385-2233
Phone (937) 376-4055

Other identifiers 3

IdentifierTypeStateIssuer
2630139MedicaidOH
2630166MedicaidOH
0245425MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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
I20041215000098 OH Practitioner - Optometry 4880651660 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3008OHMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Myeyedr Optometry of Ohio, LLC Optometrist CurrentSince Nov 2, 2022 Accepting new patients
Myeyedr Optometry of Ohio, LLC Optometrist Current Accepting new patients
Myeyedr Optometry of Ohio, LLC Optometrist CurrentSince Nov 2, 2022 Accepting new patients
Greene County Eye Care, Inc. Optometrist PastSince Jun 1, 2019 Accepting new patients

Locations

8254 Mayberry Sq N
Sylvania, OH 43560
Phone (419) 885-5300

8614 Westwood Center Dr
Fl 9
Vienna, VA 22182

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1154304000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1196121600000",
    "number": "1104832112",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "322 N DETROIT ST",
            "city": "XENIA",
            "state": "OH",
            "postal_code": "453852233",
            "telephone_number": "937-376-4055",
            "fax_number": "937-376-3969"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "322 N DETROIT ST",
            "city": "XENIA",
            "state": "OH",
            "postal_code": "453852233",
            "telephone_number": "937-376-4055",
            "fax_number": "937-376-3969"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WHEELER",
        "first_name": "STEPHEN",
        "middle_name": "KING",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-31",
        "last_updated": "2007-11-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OH",
            "license": "3006",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2630139",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2630166",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0245425",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Xenia, OH

Sources for this page

Verify at the official NPI Registry.