Active NPI
Lorna Katrina Wilson, OD
- Optometrist
- Columbia, SC
National Provider Identifier
1710064142
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 1123
- Practice address
- 4699 Forest Dr
Columbia, SC 29206-3159 - Phone
- (803) 787-3080
- Fax
- (803) 738-0070
- NPI assigned
- Nov 1, 2006
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Optometrist | 152W00000X | 1123 | SC | Primary |
Addresses
Primary practice location
4699 Forest Dr
Columbia, SC 29206-3159
Mailing address
31519 Winterplace Pkwy
Suite 2
Salisbury, MD 21804-1894
Phone (410) 749-1545
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| DA9957 | Medicaid | SC |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1123 | SC | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162339200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1201564800000",
"number": "1710064142",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "31519 WINTERPLACE PKWY",
"address_2": "SUITE 2",
"city": "SALISBURY",
"state": "MD",
"postal_code": "218041894",
"telephone_number": "410-749-1545",
"fax_number": "410-742-3707"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4699 FOREST DR",
"city": "COLUMBIA",
"state": "SC",
"postal_code": "292063159",
"telephone_number": "803-787-3080",
"fax_number": "803-738-0070"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "LORNA",
"middle_name": "KATRINA",
"name_prefix": "Dr.",
"credential": "OD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-11-01",
"last_updated": "2008-01-29",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "SC",
"license": "1123",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "DA9957",
"state": "SC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Columbia, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.