Nolan Lee Wilson, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

OPC5648 Issued in FL

Practice address

655 Brandon Town Center Mall
Brandon, FL 33511-4770

Phone

(813) 681-1036

NPI assigned

Jun 23, 2019

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

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1561248000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1561248000000",
    "number": "1669033569",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5015 BELMONT RD",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336471319",
            "telephone_number": "813-787-5995"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "655 BRANDON TOWN CENTER MALL",
            "city": "BRANDON",
            "state": "FL",
            "postal_code": "335114770",
            "telephone_number": "813-681-1036"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "NOLAN",
        "middle_name": "LEE",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-06-23",
        "last_updated": "2019-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "FL",
            "license": "OPC5648",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "www.mycigna.com",
            "affiliation": "N",
            "address_1": "5015 Belmont Rd",
            "city": "Tampa",
            "state": "FL",
            "country_code": "US",
            "postal_code": "336471319",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Emily Sara Wilson, SLP
• Herbert Wilson
• Linda M. Wilson, M.D.
• Mark Joseph Wilson, O.D.
• Matthew Ben Wilson, D.C.
• Steven A. Wilson, D.C.
• Tahesha Rene Wilson
• Win Life Psychiatric Care
• Justin Winas Jr., DO
• Brittany Wingo, MS CCC SLP

• Optometrist in Brandon, FL
• Providers in Brandon, FL by specialty
• Optometrist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2019; 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.