Individual provider Active NPI

Thomas Matlock Wyman, OD

  • Optometrist
  • Prince George, VA
National Provider Identifier
1881362960
Registry record updated Sep 2, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
0618003067 Issued in VA
Practice address
2015 Waterside Rd
Prince George, VA 23875-1265
Phone
(804) 287-4200
NPI assigned
Sep 2, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 2, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 0618003067 VA Primary

Addresses

Primary practice location

2015 Waterside Rd
Prince George, VA 23875-1265

Mailing address

202 Windmere Dr
Colonial Heights, VA 23834-2151
Phone (385) 204-1718

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
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
I20211021000874 VA Practitioner - Optometry 7517355779 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Southern College of Optometry, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Eye Surgeons of Richmond IncGroup PAC ID 5799778320, 44 clinicians

Practice addresses (Care Compare)

2015 Waterside Rd
Prince George, VA 23875-1265
Phone (804) 287-4200

Merit-based Incentive Payment System (MIPS)

Final score
84.26 of 100Reported as group
Quality
81.98
Promoting interoperability
99
Improvement activities
40
Cost
66.39

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Eye Surgeons of Richmond, Inc. CurrentSince Sep 7, 2021 Accepting new patients
Eye Surgeons of Richmond, Inc. CurrentSince Sep 7, 2021 Accepting new patients
Eye Surgeons of Richmond, Inc. Optometrist Current Accepting new patients
Virginia Eye Institute Inc Past Accepting new patients

Locations

11601 Iron Bridge Rd
Ste 104
Chester, VA 23831
Phone (804) 285-5330

11601 Iron Bridge Rd
Ste 200
Chester, VA 23831
Phone (804) 340-5730

8120 Pleasant Grove Rd
Ste 100
Mechanicsville, VA 23116

611 Watkins Centre Pkwy
Ste 100
Midlothian, VA 23114
Phone (804) 287-4412

2015 Waterside Rd
Prince George, VA 23875
Phone (804) 733-7300

6946 Forest Ave
Ste 100
Richmond, VA 23230
Phone (804) 287-2020

12018 W Broad St
Ste 102
Richmond, VA 23233
Phone (804) 287-2022

400 Westhampton Sta
Richmond, VA 23226

6946 Forest Ave
Richmond, VA 23230
Phone (804) 287-2020

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/AICDBD

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1630540800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1630540800000",
    "number": "1881362960",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "202 WINDMERE DR",
            "city": "COLONIAL HEIGHTS",
            "state": "VA",
            "postal_code": "238342151",
            "telephone_number": "385-204-1718"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2015 WATERSIDE RD",
            "city": "PRINCE GEORGE",
            "state": "VA",
            "postal_code": "238751265",
            "telephone_number": "804-287-4200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WYMAN",
        "first_name": "THOMAS",
        "middle_name": "MATLOCK",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-09-02",
        "last_updated": "2021-09-02",
        "certification_date": "2021-09-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "VA",
            "license": "0618003067",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Prince George, VA

Sources for this page

Verify at the official NPI Registry.