Tyler Andrew Wills, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

OPC005918 Issued in FL

Practice address

6 S 14TH St
Fernandina Beach, FL 32034-3212

Phone

(904) 261-5741

NPI assigned

Apr 21, 2021

Last updated

Jul 11, 2024By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

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

Specialty

Optometry

Education

Southern California College of Optometry, 2021

Medicare assignment

May accept Medicare assignment

Group practices

Dr. Ted Brink and Associates PAGroup PAC ID 6800936360, 12 clinicians

Russell Stackhouse MD PAGroup PAC ID 9133473325, 13 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

92.84 of 100Reported as group

Quality

85.67

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Dr. Ted Brink and Associates PA

  • Optometrist
  • Jacksonville, FL
  • NPI 1427138650
  Medicare reassignment Care Compare group NPD
• Russell Stackhouse MD PA

  dba Coastal Vision Center

  • Ophthalmology Physician
  • Fernandina, FL
  • NPI 1538655014

  Multi-Specialty

  Medicare reassignment Care Compare group NPD
• Dr.Ted Brink & Associates

  • Optometrist
  • Jacksonville, FL
  • NPI 1730402686
  NPD

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

{
    "created_epoch": "1618963200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720656000000",
    "number": "1740861640",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6 S 14TH ST",
            "city": "FERNANDINA BEACH",
            "state": "FL",
            "postal_code": "320343212",
            "telephone_number": "904-657-1055"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6 S 14TH ST",
            "city": "FERNANDINA BEACH",
            "state": "FL",
            "postal_code": "320343212",
            "telephone_number": "904-261-5741"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLS",
        "first_name": "TYLER",
        "middle_name": "ANDREW",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-04-21",
        "last_updated": "2024-07-11",
        "certification_date": "2024-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "FL",
            "license": "OPC005918",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Grant Tyler Whittaker, M.D.
• Jacquelyn J Wicker, APRN
• Wynne Alys Wilking
• William L Ross (Amelia Psychological Services)
• Kedra Fields Williams, M.D.
• Rosemary T Wilson, APRN
• Shelly Fulford Wilson, LCSW
• Amir Wind, MD
• Ross Davin Wise, APRN
• Women's Care Florida LLC

• Optometrist in Fernandina Beach, FL
• Providers in Fernandina Beach, FL by specialty
• Optometrist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.