Active NPI
Myron Wilson, O.D.
- Optometrist
- Centre, AL
National Provider Identifier
1922110758
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- S-542-TA-135
- Practice address
- 280 W Main St
Centre, AL 35960-1326 - Phone
- (256) 927-4030
- Fax
- (256) 927-2586
- NPI assigned
- Aug 31, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | S-542-TA-135 | AL | Primary |
Addresses
Primary practice location
280 W Main St
Centre, AL 35960-1326
Mailing address
280 W Main St
Centre, AL 35960-1326
Phone (256) 927-4030
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000059743 | Medicaid | AL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| S-542-TA-135 | AL | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156982400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1275955200000",
"number": "1922110758",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "280 W MAIN ST",
"city": "CENTRE",
"state": "AL",
"postal_code": "359601326",
"telephone_number": "256-927-4030",
"fax_number": "256-927-2586"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "280 W MAIN ST",
"city": "CENTRE",
"state": "AL",
"postal_code": "359601326",
"telephone_number": "256-927-4030",
"fax_number": "256-927-2586"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "MYRON",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-31",
"last_updated": "2010-06-08",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "AL",
"license": "S-542-TA-135",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "000059743",
"state": "AL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Centre, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.