Dexter E. Wilson, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

1657 Issued in IA

Practice address

918 Decathlon Dr
Waterloo, IA 50701-3441

Phone

(319) 236-2020

NPI assigned

Sep 7, 2005

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 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Kaila Egan O.D., PLLC

  • Optometrist
  • Waterloo, IA
  • NPI 1598199218
  NPD (past)

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

{
    "created_epoch": "1126051200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1205366400000",
    "number": "1902890858",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "918 DECATHLON DR",
            "city": "WATERLOO",
            "state": "IA",
            "postal_code": "507013441",
            "telephone_number": "319-236-2020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "918 DECATHLON DR",
            "city": "WATERLOO",
            "state": "IA",
            "postal_code": "507013441",
            "telephone_number": "319-236-2020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "DEXTER",
        "middle_name": "E.",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-07",
        "last_updated": "2008-03-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IA",
            "license": "1657",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6146811",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• John Eustis Williams, PH.D.
• Jacqueline Willms, PHARM.D.
• Paul Richard Willy, DENTIST DDS
• Wilson Family Chiropractic Center Inc.
• Angela Wilson-Anderson, LMSW
• Stacy Caye Wilson
• Zachary Paul Wilson, D.C.
• Abigail Renee Winder
• Kerry R Winkel, RN
• Michael Jay Wirth, DDS

• Optometrist in Waterloo, IA
• Providers in Waterloo, IA by specialty
• Optometrist in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.