Individual provider Active NPI

Frank Willis Wyant Jr., D.O.

  • Ophthalmology Physician
  • Albuquerque, NM
National Provider Identifier
1497740989
Registry record updated Apr 25, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
A-864-87 Issued in NM
Practice address
806 Dr. MLK Jr. Ave., NE
Albuquerque, NM 87102
Phone
(505) 842-6575
Fax
(505) 764-8796
NPI assigned
Sep 12, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 25, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology Physician 207W00000X A-864-87 NM Primary

Addresses

Primary practice location

806 Dr. MLK Jr. Ave., NE
Albuquerque, NM 87102

Mailing address

8801 Horizon Blvd NE
Suite 360
Albuquerque, NM 87113-1533
Phone (505) 828-4923

Other identifiers 4

IdentifierTypeStateIssuer
40394MedicaidNM
180014481OtherNMRRB MEDICARE RAILROAD
NM004657OtherNMBC BS OF NM
279712MedicaidAZ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NM
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20091202000525 NM Practitioner - Ophthalmology 4587625413 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
A-864-87NMMDOphthalmology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Eye Associates of New Mexico LTD Ophthalmology CurrentSince Sep 12, 1988 Accepting new patients
Eye Associates of New Mexico LTD Ophthalmology CurrentSince Sep 12, 1988 Accepting new patients

Locations

8801 Horizon Blvd NE
Ste 360
Albuquerque, NM 87113
Phone (505) 246-2622

806 Martin Luther King Ave NE
Albuquerque, NM 87102
Phone (505) 842-6575

622 W Maple St
Ste E
Farmington, NM 87401
Phone (505) 325-4003

2947 Rodeo Park Dr E
Santa Fe, NM 87505
Phone (505) 474-9880

Interoperability endpoints

  • Direct secure messaging: fwyant33180@ahs.direct-ci.com

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1126483200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1209081600000",
    "number": "1497740989",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8801 HORIZON BLVD NE",
            "address_2": "SUITE 360",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871131533",
            "telephone_number": "505-828-4923",
            "fax_number": "505-213-0103"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "806 DR. MLK JR. AVE., NE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "87102",
            "telephone_number": "505-842-6575",
            "fax_number": "505-764-8796"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WYANT",
        "first_name": "FRANK",
        "middle_name": "WILLIS",
        "name_suffix": "Jr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-12",
        "last_updated": "2008-04-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "NM",
            "license": "A-864-87",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "40394",
            "state": "NM"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RRB MEDICARE RAILROAD",
            "identifier": "180014481",
            "state": "NM"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC BS OF NM",
            "identifier": "NM004657",
            "state": "NM"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "279712",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Albuquerque, NM

Sources for this page

Verify at the official NPI Registry.