Wilson Eyecare Professionals PC

Primary specialty

OptometristTaxonomy code 152W00000X

License

18002895AB Issued in IN

Legal business name

WILSON EYECARE PROFESSIONALS PC

Practice address

400 W Green Meadows Dr
Suite 108
Greenfield, IN 46140-3204

Phone

(317) 477-3937

Fax

(317) 477-3939

NPI assigned

Sep 27, 2011

Organization subpart

No

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

Authorized official

Name

Dr. Douglas J Wilson, O.D.NPI 1235138876

Title

Ceo and Doctor

Phone

(317) 477-3937

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in IN2 enrollments

Enrollment records 2

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Douglas J Wilson, OD

  • Optometrist
  • Greenfield, IN
  • NPI 1235138876
  Medicare reassignment Authorized official
• Kelley Lynn Deak, O.D.

  • Optometrist
  • Columbus, IN
  • NPI 1184728123
  Medicare reassignment NPD
• Kasey Stolle, OD

  • Optometrist
  • Greenfield, IN
  • NPI 1215420294
  Medicare reassignment
• James Robert Sloan, OD

  • Optometrist
  • Sherman Oaks, CA
  • NPI 1639480510
  NPD (past)

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

{
    "created_epoch": "1317081600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1323734400000",
    "number": "1669755575",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 W GREEN MEADOWS DR",
            "address_2": "SUITE 108",
            "city": "GREENFIELD",
            "state": "IN",
            "postal_code": "461403204",
            "telephone_number": "317-477-3937",
            "fax_number": "317-477-3939"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 W GREEN MEADOWS DR",
            "address_2": "SUITE 108",
            "city": "GREENFIELD",
            "state": "IN",
            "postal_code": "461403204",
            "telephone_number": "317-477-3937",
            "fax_number": "317-477-3939"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILSON EYECARE PROFESSIONALS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-09-27",
        "last_updated": "2011-12-13",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "DOUGLAS",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CEO AND DOCTOR",
        "authorized_official_telephone_number": "317-477-3937",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "IN",
            "license": "18002895AB",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BLUE CROSS AND BLUE SHIELD",
            "identifier": "000000176992",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VSP",
            "identifier": "JARTL",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EYEMED",
            "identifier": "IN2895",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200280210",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kalen Leigh Wilkes, PA
• Jennifer Wilkinson, PHARMD
• Delynn M Williams, M.D.
• Ragan Michelle Williams
• Reginald Michael Williams Jr.
• Wilson Optometry PC
• Douglas J Wilson, OD
• Renee Anne Wilson, NP
• Scott D Wilson, LCSW, LCAC
• Dionne Wofford

• Optometrist in Greenfield, IN
• Providers in Greenfield, IN by specialty
• Optometrist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2011; 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.