Roger L. Wilson, O.D., P.a.

Primary specialty

Corneal and Contact Management OptometristTaxonomy code 152WC0802X

License

OP2569 Issued in FL

Legal business name

ROGER L. WILSON, O.D., P.A.

Practice address

110 Solana Rd
Ponte Vedra Beach, FL 32082-2230

Phone

(904) 280-2021

Fax

(904) 280-2024

NPI assigned

May 11, 2008

Organization subpart

No

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

Authorized official

Name

Dr. Roger L. Wilson, O.D.NPI 1215032370

Title

President

Phone

(904) 280-2021

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

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.

• Roger L. Wilson, O.D.

  • Optometrist
  • Ponte Vedra Beach, FL
  • NPI 1215032370
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1210464000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1210464000000",
    "number": "1164699054",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 SOLANA RD",
            "city": "PONTE VEDRA BEACH",
            "state": "FL",
            "postal_code": "320822230",
            "telephone_number": "904-280-2021",
            "fax_number": "904-280-2024"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 SOLANA RD",
            "city": "PONTE VEDRA BEACH",
            "state": "FL",
            "postal_code": "320822230",
            "telephone_number": "904-280-2021",
            "fax_number": "904-280-2024"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROGER L. WILSON, O.D., P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-11",
        "last_updated": "2008-05-11",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "ROGER",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "904-280-2021",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152WC0802X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "FL",
            "license": "OP2569",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nathan Adam Riddle, D.C.
• Emily B Riegel, M.ED. , L.M.H.C., PA
• Allie Marie Robertson, M.A., BCBA
• Megan Amelia Rodriguez
• Hannah Tedder Roffino
• Shawna Marie Rohrer, RMHCI
• Claudia Rojas-Baisden, LMHC
• Jessica Roller, PHARMD
• Alexis Romero, DC
• Thomas Alfred Romero, DC

• Corneal and Contact Management Optometrist in Ponte Vedra Beach, FL
• Providers in Ponte Vedra Beach, FL by specialty
• Corneal and Contact Management Optometrist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2008; 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.