Individual provider Active NPI

Justin Wilkinson, OD

  • Optometrist
  • Webster Groves, MO
National Provider Identifier
1821251422
Registry record updated Nov 18, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2009010664 Issued in MO
Practice address
8658 Big Bend Blvd
Webster Groves, MO 63119-3839
Phone
(314) 968-4243
Fax
(314) 968-3273
NPI assigned
Jul 3, 2008
Last updated
Nov 18, 2014By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 18, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 2009010664 MO Primary

Addresses

Primary practice location

8658 Big Bend Blvd
Webster Groves, MO 63119-3839

Mailing address

40 E North St
Eureka, MO 63025-1205
Phone (636) 200-4393

Other identifiers 1

IdentifierTypeStateIssuer
1821251422MedicaidMO

Medicare participation

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

Enrollment IDStateProvider typePAC IDDetails
I20100722000033 MO Practitioner - Optometry 7911039276 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
University of Missouri St Louis - School of Optometry, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Clarkson Optometry IncGroup PAC ID 0840411799, 82 clinicians

Practice addresses (Care Compare)

3122 S Grand Blvd
The Spec Shoppe
St Louis, MO 63118-1012
Phone (314) 450-7313

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2009010664MOMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Clarkson Optometry Inc Optometrist Past Accepting new patients
Clarkson Optometry Inc Optometrist Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: justinwilkinson@direct.eyecare-partners.com

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1215043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1416268800000",
    "number": "1821251422",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "40 E NORTH ST",
            "city": "EUREKA",
            "state": "MO",
            "postal_code": "630251205",
            "telephone_number": "636-200-4393",
            "fax_number": "636-938-2650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8658 BIG BEND BLVD",
            "city": "WEBSTER GROVES",
            "state": "MO",
            "postal_code": "631193839",
            "telephone_number": "314-968-4243",
            "fax_number": "314-968-3273"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILKINSON",
        "first_name": "JUSTIN",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-07-03",
        "last_updated": "2014-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MO",
            "license": "2009010664",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1821251422",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Webster Groves, MO

Sources for this page

Verify at the official NPI Registry.