Teresa Ann Wise, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

1156DT Issued in KY

Practice address

2904 Dolphin Dr
Elizabethtown, KY 42701-7102

Phone

(270) 769-3708

Fax

(270) 765-2043

NPI assigned

Jan 9, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1168300800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1210636800000",
    "number": "1114076288",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2904 DOLPHIN DR",
            "city": "ELIZABETHTOWN",
            "state": "KY",
            "postal_code": "42701",
            "telephone_number": "270-769-3708",
            "fax_number": "270-765-2043"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2904 DOLPHIN DR",
            "city": "ELIZABETHTOWN",
            "state": "KY",
            "postal_code": "427017102",
            "telephone_number": "270-769-3708",
            "fax_number": "270-765-2043"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WISE",
        "first_name": "TERESA",
        "middle_name": "ANN",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-09",
        "last_updated": "2008-05-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "KY",
            "license": "1156DT",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "77-0011567",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "770011567",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tina L Wilson, ARNP RN
• Paul Dean Wimp, HEARING INSTRUMENT S
• Wisdom Key Behavioral Health Services Inc
• Christopher E Wise, MHA
• Madelyn M Wise
• Nancy Darlene Witten, ARNP
• William Witzel, MS, LAT, ATC
• Bruce Alexander Wolf, MD
• Dana Wolfer, DO
• Ailyn Wood

• Optometrist in Elizabethtown, KY
• Providers in Elizabethtown, KY by specialty
• Optometrist in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 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.