Timothy N Wilson, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

046009848 Issued in IL

Practice address

7601 University Ave
#102
Middleton, WI 53562-5414

Phone

(608) 831-3366

Fax

(608) 831-8470

NPI assigned

Sep 22, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in WI

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

Illinois College of Optometry at Chicago, 2006

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Isthmus Eye Care SCGroup PAC ID 9032011002, 8 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: twilson@direct.revolutionehr.com

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.

• Isthmus Eye Care SC

  • Optometrist
  • Middleton, WI
  • NPI 1578554390
  Medicare reassignment Care Compare group NPD
• University of South Alabama Health Care Authority

  • Internal Medicine Physician
  • Mobile, AL
  • NPI 1508392432
  NPD (past)

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

{
    "created_epoch": "1158883200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1372291200000",
    "number": "1811097702",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7601 UNIVERSITY AVE",
            "address_2": "#102",
            "city": "MIDDLETON",
            "state": "WI",
            "postal_code": "535625414",
            "telephone_number": "608-831-3366",
            "fax_number": "608-831-8470"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7601 UNIVERSITY AVE",
            "address_2": "#102",
            "city": "MIDDLETON",
            "state": "WI",
            "postal_code": "535625414",
            "telephone_number": "608-831-3366",
            "fax_number": "608-831-8470"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "TIMOTHY",
        "middle_name": "N",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-22",
        "last_updated": "2013-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046009848",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "046009848",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "OPT-2565",
            "state": "CO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "3108-035",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Jennifer Lynne Wilgocki, MS
• Kristen Wilkinson, PSY.D.
• Christopher J Wirth, MS LMFT
• Wisconsin CVS Pharmacy LLC
• Wisconsin Fertility and Reproductive Surgery Associates SC
• Wisconsin Medical Transport LLC
• Heather A Wise

• Optometrist in Middleton, WI
• Providers in Middleton, WI by specialty
• Optometrist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2013; 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.