Individual provider Active NPI

Ryan Wiggins, O.D.

  • Optometrist
  • Phoenix, AZ
National Provider Identifier
1679738512
Registry record updated Mar 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
1626 Issued in AZ
Practice address
21001 N Tatum Blvd Ste 74-1570
Phoenix, AZ 85050-5228
Phone
(480) 538-9811
Fax
(480) 538-9809
NPI assigned
Jul 21, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 952 NV
Optometrist 152W00000X 1626 AZ Primary

Addresses

Primary practice location

21001 N Tatum Blvd Ste 74-1570
Phoenix, AZ 85050-5228

Mailing address

220 N McKemy Ave
Chandler, AZ 85226-2654
Phone (480) 961-1865

Other practice location 1

220 N McKemy Ave
Chandler, AZ 85226-2654
Phone (480) 961-1865

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080904000376 AZ Practitioner - Optometry 9830265586 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1626AZMDOptometrist
952NVMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Nationwide Optometry P.C. Optometrist Past Accepting new patients
Nationwide Optometry P.C. Optometrist PastSince Sep 1, 2022 Accepting new patients

Interoperability endpoints

  • Direct secure messaging: ryanwiggins@direct.eyecare-partners.com

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1216598400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1679738512",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "220 N MCKEMY AVE",
            "city": "CHANDLER",
            "state": "AZ",
            "postal_code": "852262654",
            "telephone_number": "480-961-1865",
            "fax_number": "480-961-4605"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21001 N TATUM BLVD STE 74-1570",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850505228",
            "telephone_number": "480-538-9811",
            "fax_number": "480-538-9809"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "220 N McKemy Ave",
            "address_purpose": "LOCATION",
            "city": "Chandler",
            "state": "AZ",
            "postal_code": "852262654",
            "country_code": "US",
            "telephone_number": "480-961-1865",
            "fax_number": "480-961-4605",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WIGGINS",
        "first_name": "RYAN",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-07-21",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NV",
            "license": "952",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "AZ",
            "license": "1626",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

Verify at the official NPI Registry.