Jeffrey F Wilson OD PC

Primary specialty

OptometristTaxonomy code 152W00000X

License

4901003093 Issued in MI

Legal business name

JEFFREY F WILSON OD PC

Practice address

126 W Wheatland Ave
Remus, MI 49340-5115

Phone

(989) 967-8668

Fax

(989) 967-3032

NPI assigned

Jan 7, 2011

Organization subpart

No

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

Authorized official

Name

Jeffrey F Wilson, ODNPI 1184727612

Title

Owner

Phone

(989) 967-8668

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jeffrey F Wilson, OD PC

  • Optometrist
  • Remus, MI
  • NPI 1184727612
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1294358400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1294358400000",
    "number": "1295039097",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "126 W WHEATLAND AVE",
            "city": "REMUS",
            "state": "MI",
            "postal_code": "493405115",
            "telephone_number": "989-967-8668",
            "fax_number": "989-967-3032"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "126 W WHEATLAND AVE",
            "city": "REMUS",
            "state": "MI",
            "postal_code": "493405115",
            "telephone_number": "989-967-8668",
            "fax_number": "989-967-3032"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEFFREY F WILSON OD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-01-07",
        "last_updated": "2011-01-07",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "989-967-8668",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "MI",
            "license": "4901003093",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4373941",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Optometrist in Remus, MI
• Providers in Remus, MI by specialty
• Optometrist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2011; 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.