NPIMap

Organization Active NPI

Wilson Polito PLLC

  • Optometrist
  • Lewiston, ID
National Provider Identifier
1710276324
Registry record updated Nov 6, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
ODP-100222 Issued in ID
Legal business name
WILSON POLITO PLLC
Practice address
739 Bryden Ave Ste a
Lewiston, ID 83501-4909
Phone
(208) 743-5830
Fax
(208) 743-5831
NPI assigned
Apr 4, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 6, 2020

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

Authorized official

Name
Nathan Wilson, ODNPI 1164523643
Title
Optometrist/President
Phone
(720) 212-8821

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X ODP-100222 ID Primary

Addresses

Primary practice location

739 Bryden Ave Ste a
Lewiston, ID 83501-4909

Mailing address

872 Troy Rd Ste 130
Moscow, ID 83843-5035
Phone (720) 212-8821

Other practice location 1

872 Troy Rd Ste 130
Moscow, ID 83843-5035
Phone (720) 212-8821

Other names 2

  • Alpine Vision Center Other name
  • Wilson Polito Inc. Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110615000542 ID Part B Supplier - Clinic/Group Practice 9931386174 Receives reassigned benefits from 7 practitioners
Practice locations: Lewiston, ID; Moscow, ID

National Provider Directory

National Provider Directory
Tax ID family
Alpine Vision Center2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

872 Troy Rd
Ste 130
Moscow, ID 83843
Phone (208) 883-1800

Practitioners & affiliated clinicians

Practitioners 8

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

NPI Registry JSON

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

{
    "created_epoch": "1301875200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1604620800000",
    "number": "1710276324",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "872 TROY RD STE 130",
            "city": "MOSCOW",
            "state": "ID",
            "postal_code": "838435035",
            "telephone_number": "720-212-8821"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "739 BRYDEN AVE STE A",
            "city": "LEWISTON",
            "state": "ID",
            "postal_code": "835014909",
            "telephone_number": "208-743-5830",
            "fax_number": "208-743-5831"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "872 Troy Rd Ste 130",
            "address_purpose": "LOCATION",
            "city": "Moscow",
            "state": "ID",
            "postal_code": "838435035",
            "country_code": "US",
            "telephone_number": "720-212-8821",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "WILSON POLITO PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-04-04",
        "last_updated": "2020-11-06",
        "certification_date": "2020-11-06",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "NATHAN",
        "authorized_official_title_or_position": "OPTOMETRIST/PRESIDENT",
        "authorized_official_telephone_number": "720-212-8821",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "ID",
            "license": "ODP-100222",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Alpine Vision Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Wilson Polito Inc.",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Alpine Vision Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Lewiston, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2020; 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.