Tristan L Wild OD PLLC

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

TRISTAN L WILD OD PLLC

Doing business as

Lakeway Vision Associates

Practice address

1700 Ranch Road 620 S Ste a
Lakeway, TX 78734-6246

Phone

(512) 263-9970

Fax

(512) 895-9903

NPI assigned

Mar 3, 2022

Last updated

Mar 3, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Tristan Wild, ODNPI 1164656716

Title

Owner

Phone

(512) 263-9970

Specialties & licenses 1

Addresses

Other names 1

• Lakeway Vision Associates Doing business as

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Tristan Leigh Wild, O.D.

  • Optometrist
  • Lakeway, TX
  • NPI 1164656716
  Medicare reassignment Care Compare group NPD Authorized official
• Nancy Ann Stehlik-Amador, O.D.

  • Optometrist
  • Lakeway, TX
  • NPI 1487766424
  Medicare reassignment Care Compare group NPD
• Pralay Atodaria

  • Optometrist
  • Lakeway, TX
  • NPI 1649193939
  NPD (past)
• Erin Raye Flores, OD

  • Optometrist
  • Killeen, TX
  • NPI 1437884426
  NPD (past)

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

{
    "created_epoch": "1646265600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1646265600000",
    "number": "1548917172",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1700 RANCH ROAD 620 S STE A",
            "city": "LAKEWAY",
            "state": "TX",
            "postal_code": "787346246",
            "telephone_number": "512-263-9970",
            "fax_number": "512-895-9903"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 RANCH ROAD 620 S STE A",
            "city": "LAKEWAY",
            "state": "TX",
            "postal_code": "787346246",
            "telephone_number": "512-263-9970",
            "fax_number": "512-895-9903"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRISTAN L WILD OD PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-03-03",
        "last_updated": "2022-03-03",
        "certification_date": "2022-03-03",
        "status": "A",
        "authorized_official_last_name": "WILD",
        "authorized_official_first_name": "TRISTAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "512-263-9970",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lakeway Vision Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Stephanie N Torres-Ramos, PH.D.
• Kristen Torres, SPEECH PATHOLOGIST
• Deanna Traubel, PT, DPT
• Katelyn C Trimba, MD
• Tripod Neurodiagnostics PLLC
• Kelly Turner, RN
• U S Anesthesia Partners of Texas
• Urgent Care Docs of Texas, PA (Urgent Care Plus William Cannon, LLC)
• Urology Austin PLLC
• Carlos Valencia

• Optometrist in Lakeway, TX
• Providers in Lakeway, TX by specialty
• Optometrist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2022; 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.