Roger L. Wilson, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

OP2569 Issued in FL

Practice address

110 Solana Rd
Ponte Vedra Beach, FL 32082-2230

Phone

(904) 280-2021

NPI assigned

Sep 14, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

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

Specialty

Optometry

Education

University Alabama Birmingham - School of Optometry, 1991

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Roger L. Wilson, O.D., P.a.

  • Corneal and Contact Management Optometrist
  • Ponte Vedra Beach, FL
  • NPI 1164699054
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1158192000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1215032370",
    "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"
        },
        {
            "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"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "ROGER",
        "middle_name": "L.",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-14",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "FL",
            "license": "OP2569",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kearra Williams
• Trina Renee Williams, ARNP
• Stephen Williamson, DPT
• Brooke L Wilson, CCC-SLP
• Neykisha Wilson
• Hilary Windsor, MS, CCC-SLP
• Nicole Lee Winter, PSY.D.
• John Theodore Woeste Jr., MD
• Jacob Marvin Wolf, M.D.
• Karen Sue Wolf, OD

• Optometrist in Ponte Vedra Beach, FL
• Providers in Ponte Vedra Beach, FL by specialty
• Optometrist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.

Verify at the official NPI Registry.