Active NPI
Douglas Mark Wilson, OD
- Optometrist
- Rutland, VT
National Provider Identifier
1235199126
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 0300000152
- Practice address
- 71 Allen St
Ste 201
Rutland, VT 05701 - Phone
- (802) 775-9355
- Fax
- (802) 775-4577
- NPI assigned
- Mar 24, 2006
- Sex
- Male
- 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 | 0300000152 | VT | Primary |
Addresses
Primary practice location
71 Allen St
Ste 201
Rutland, VT 05701
Mailing address
71 Allen St
Ste 201
Rutland, VT 05701
Phone (802) 775-9355
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| OVN0576 | Medicaid | VT |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in VT
- 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
- Ohio State University - College of Optometry, 1972
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
71 Allen St
Suite 201
Rutland, VT 05701-4570
Phone (802) 775-9355
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0300000152 | VT | MD | Optometrist |
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 and National Provider Directory roles.
-
- Optometrist
- Rutland, VT
- NPI 1639390552
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1143158400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1380153600000",
"number": "1235199126",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "71 ALLEN ST",
"address_2": "STE 201",
"city": "RUTLAND",
"state": "VT",
"postal_code": "05701",
"telephone_number": "802-775-9355",
"fax_number": "802-775-4577"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "71 ALLEN ST",
"address_2": "STE 201",
"city": "RUTLAND",
"state": "VT",
"postal_code": "05701",
"telephone_number": "802-775-9355",
"fax_number": "802-775-4577"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "DOUGLAS",
"middle_name": "MARK",
"credential": "OD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-03-24",
"last_updated": "2013-09-26",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "VT",
"license": "0300000152",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "OVN0576",
"state": "VT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Rutland, VT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2013; 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.