Active NPI
Tyrone Ervin Wilson
- Optician
- Dorchester, MA
National Provider Identifier
1700602174
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optician
- License
- 6629
- Practice address
- 98 Dakota St Apt 2
Dorchester, MA 02124-1270 - Phone
- (857) 406-9883
- NPI assigned
- Dec 2, 2024
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optician | 156FX1800X | 6629 | MA | Primary |
Addresses
Primary practice location
98 Dakota St Apt 2
Dorchester, MA 02124-1270
Mailing address
757 Gallivan Blvd Ste 1
Dorchester, MA 02122-3190
Phone (857) 406-9883
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| FHIR URL | www.w5studio.com | Health Information Exchange (HIE) |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6629 | MA | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1733097600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1733616000000",
"number": "1700602174",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "757 GALLIVAN BLVD STE 1",
"city": "DORCHESTER",
"state": "MA",
"postal_code": "021223190",
"telephone_number": "857-406-9883"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "98 DAKOTA ST APT 2",
"city": "DORCHESTER",
"state": "MA",
"postal_code": "021241270",
"telephone_number": "857-406-9883"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "TYRONE",
"middle_name": "ERVIN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-12-02",
"last_updated": "2024-12-08",
"certification_date": "2024-12-08",
"status": "A"
},
"taxonomies": [
{
"code": "156FX1800X",
"taxonomy_group": "",
"desc": "Technician/Technologist, Optician",
"state": "MA",
"license": "6629",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "FHIR",
"endpointTypeDescription": "FHIR URL",
"endpoint": "www.w5studio.com",
"affiliation": "N",
"endpointDescription": "Website to order prescription eyewear",
"use": "HIE",
"useDescription": "Health Information Exchange (HIE)",
"useOtherDescription": "www.w5studio.com",
"contentType": "CSV",
"contentTypeDescription": "CSV",
"address_1": "98 Dakota St Apt 2",
"city": "Dorchester",
"state": "MA",
"country_code": "US",
"postal_code": "021241270",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Dorchester, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.