Derek Jason Wills, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

1436 Issued in NE

Practice address

7474 Towne Center Pkwy
Ste 107
Papillion, NE 68046-4805

Phone

(402) 592-3266

NPI assigned

May 21, 2015

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

State licenses

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

{
    "created_epoch": "1432166400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1432166400000",
    "number": "1588043616",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4925 COPPER HILL DR",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681572920",
            "telephone_number": "402-305-4494"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7474 TOWNE CENTER PKWY",
            "address_2": "STE 107",
            "city": "PAPILLION",
            "state": "NE",
            "postal_code": "680464805",
            "telephone_number": "402-592-3266"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLS",
        "first_name": "DEREK",
        "middle_name": "JASON",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-05-21",
        "last_updated": "2015-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NE",
            "license": "1436",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kiley Renee Williamson
• Jessica Williar
• Matthew Luke Willis, O.D.
• Rosemary Willis
• Willow Dental Papillion LLC
• Mackenzie Breanne Wills
• Caitlin Helene Wilsey, RN
• Camene E. Wilson, PHARMD
• Daniel Lamont Wilson
• John Steven Wilson

• Optometrist in Papillion, NE
• Providers in Papillion, NE by specialty
• Optometrist in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.