Individual provider Active NPI

Willane A. Wylie, O.D.

  • Optometrist
  • Charlotte, NC
National Provider Identifier
1174747836
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
1824 Issued in NC
Practice address
9820 Callabridge CT
Charlotte, NC 28216-7669
Phone
(704) 398-9115
Fax
(704) 392-3141
NPI assigned
Apr 12, 2007
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 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 1824 NC Primary

Addresses

Primary practice location

9820 Callabridge CT
Charlotte, NC 28216-7669

Mailing address

1948 Oroville CT
Charlotte, NC 28214-2567
Phone (704) 575-6796

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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
I20090925000253 NC Practitioner - Optometry 4183770506 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1824NCMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Eyecarecenter, O.D., P.a. Optometrist CurrentSince Oct 1, 2021 Accepting new patients
Eyecarecenter OD PA Optometrist Current Accepting new patients
Eyecarecenter OD PA Optometrist CurrentSince Oct 1, 2021 Accepting new patients
Dr. Melanie S. Kiser PC Optometrist PastSince Aug 15, 2013 Accepting new patients

Locations

819 Tiffany Blvd
Rocky Mount, NC 27804
Phone (252) 972-2020

Organizations & group practices 6

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": "1176336000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1174747836",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1948 OROVILLE CT",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282142567",
            "telephone_number": "704-575-6796",
            "fax_number": "704-392-3141"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9820 CALLABRIDGE CT",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282167669",
            "telephone_number": "704-398-9115",
            "fax_number": "704-392-3141"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WYLIE",
        "first_name": "WILLANE",
        "middle_name": "A.",
        "name_prefix": "Ms.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-12",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NC",
            "license": "1824",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

Verify at the official NPI Registry.