Active NPI
Tristan Leigh Wild, O.D.
- Optometrist
- Lakeway, TX
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 7438T
- Practice address
- 1700 Ranch Road 620 S
#A
Lakeway, TX 78734-6245 - Phone
- (512) 263-9970
- NPI assigned
- May 12, 2009
- Last updated
- Jul 5, 2009
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 7438T | TX | Primary |
Addresses
Primary practice location
1700 Ranch Road 620 S
#A
Lakeway, TX 78734-6245
Mailing address
7201 Ranch Road 2222
#2116
Austin, TX 78730-3208
Phone (901) 626-4940
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Optometry
- Education
- Southern College of Optometry, 2009
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
1700 Ranch Rd 620
Suite a
Lakeway, TX 78734-6246
Phone (512) 263-9970
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7438 | TX | MD | General Practice Dentistry |
| 7438T | TX | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Tristan L Wild OD PLLC | Optometrist | Current | Accepting new patients |
Locations
1700 Ranch Road 620 S
Lakeway, TX 78734
Phone (512) 263-9970
1700 Ranch Road 620 S
Ste A
Lakeway, TX 78734
Phone (512) 263-9970
Organizations & group practices 1
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": "1242086400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1246752000000",
"number": "1164656716",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7201 RANCH ROAD 2222",
"address_2": "#2116",
"city": "AUSTIN",
"state": "TX",
"postal_code": "787303208",
"telephone_number": "901-626-4940"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1700 RANCH ROAD 620 S",
"address_2": "#A",
"city": "LAKEWAY",
"state": "TX",
"postal_code": "787346245",
"telephone_number": "512-263-9970"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILD",
"first_name": "TRISTAN",
"middle_name": "LEIGH",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-05-12",
"last_updated": "2009-07-05",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "TX",
"license": "7438T",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lakeway, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.