Alexis R Wylam, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

OEG004023 Issued in PA

Practice address

281 Airport Rd
Hazle Township, PA 18202-3320

Phone

(570) 453-2020

NPI assigned

Jun 27, 2023

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in PA

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

Other, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Dr Sandra M Krokos and Thomas P Kislan PCGroup PAC ID 6406842202, 10 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

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.

• DRS Sandra M Krokos & Thomas P Kislan PC

  • Optometrist
  • Tannersville, PA
  • NPI 1487784005
  Medicare reassignment Care Compare group NPD
• DRS Sandra M Krokos & Thomas P Kislan PC

  • Optometrist
  • Nanticoke, PA
  • NPI 1053010926
  NPD
• DRS Sandra M Krokos & Thomas P Kislan PC

  • Optometrist
  • Tannersville, PA
  • NPI 1609634799
  NPD

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

{
    "created_epoch": "1687824000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687996800000",
    "number": "1275219818",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "312 COUNTRYWOOD DR",
            "city": "HANOVER TOWNSHIP",
            "state": "PA",
            "postal_code": "187065311",
            "telephone_number": "570-606-9234"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "281 AIRPORT RD",
            "city": "HAZLE TOWNSHIP",
            "state": "PA",
            "postal_code": "182023320",
            "telephone_number": "570-453-2020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WYLAM",
        "first_name": "ALEXIS",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-06-27",
        "last_updated": "2023-06-29",
        "certification_date": "2023-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152WC0802X",
            "taxonomy_group": "",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "PA",
            "license": "OEG004023",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "PA",
            "license": "OEG004023",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wal-Mart Stores East LP
• Wal-Mart Stores East, LP.
• Ashley Rae Walicki, CRNP
• Alyssa Jo Williams, RDN, LDN
• Rachel Witner
• Linda Yan
• Leeann Yetter
• Gina Yocum, CCC-SLP
• Yocums Pharmacy 2 Inc
• Joseph Yoo, M.D.

• Optometrist in Hazle Township, PA
• Providers in Hazle Township, PA by specialty
• Optometrist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2023; 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.