Wilson King Wallace, MD

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

ME18644 Issued in FL

Practice address

2750 Indian River Blvd
Vero Beach, FL 32960-5225

Phone

(772) 569-9500

Fax

(772) 569-9507

NPI assigned

Oct 18, 2005

Sex

Male

Sole proprietor

No

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

Enrolled in FL

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• Florida Eye Institute, P.a.

  • Specialist
  • Vero Beach, FL
  • NPI 1053356337

  Ophthalmology

  Medicare reassignment NPD
• Bedotto Wallace Clewner & Kelly, MD, PA

  • Ophthalmology Physician
  • Boca Raton, FL
  • NPI 1285654723
  NPD (past)

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

{
    "created_epoch": "1129593600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1271203200000",
    "number": "1598754053",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2750 INDIAN RIVER BLVD",
            "city": "VERO BEACH",
            "state": "FL",
            "postal_code": "329605225",
            "telephone_number": "772-569-9500",
            "fax_number": "772-569-9507"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2750 INDIAN RIVER BLVD",
            "city": "VERO BEACH",
            "state": "FL",
            "postal_code": "329605225",
            "telephone_number": "772-569-9500",
            "fax_number": "772-569-9507"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "WILSON",
        "middle_name": "KING",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-18",
        "last_updated": "2010-04-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "FL",
            "license": "ME18644",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Walgreen Co (Walgreens #01127)
• Kelly Elizabeth Walker, LMT
• Odane Walker
• Lisa Laura Wall, PA
• Cynthia Catherine Wallace, P.A.
• Conor Walsh, PHARMD
• Laura Leigh Walsh, PA
• Piper Walsh, LMHC
• Patricia Pinaya Walters, MD
• Melissa A Walther, MD

• Ophthalmology Physician in Vero Beach, FL
• Providers in Vero Beach, FL by specialty
• Ophthalmology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2010; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.