Active NPI
Robert L Wilson, OD
- Optometrist
- Prosser, WA
National Provider Identifier
1952484446
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- OD00001687
- Practice address
- 617 Market Street
Prosser, WA 99350-1341 - Phone
- (509) 786-3111
- Fax
- (509) 786-3188
- NPI assigned
- Oct 20, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 | OD00001687 | WA | Primary |
Addresses
Primary practice location
617 Market Street
Prosser, WA 99350-1341
Mailing address
617 Market St
Prosser, WA 99350-1341
Phone (509) 786-3111
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2020584 | Medicaid | WA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 2
Other NPIs on the same Medicare enrollment 1
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OD00001687 | WA | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wilson Family Eyecare PS | Optometrist | Current | Accepting new patients |
Locations
617 Market St
Prosser, WA 99350
Phone (509) 786-3111
Organizations & group practices 1
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.
-
- Optometrist
- Prosser, WA
- NPI 1871846030
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161302400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1255651200000",
"number": "1952484446",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "617 MARKET ST",
"city": "PROSSER",
"state": "WA",
"postal_code": "993501341",
"telephone_number": "509-786-3111",
"fax_number": "509-786-3188"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "617 MARKET STREET",
"city": "PROSSER",
"state": "WA",
"postal_code": "993501341",
"telephone_number": "509-786-3111",
"fax_number": "509-786-3188"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "ROBERT",
"middle_name": "L",
"name_prefix": "Dr.",
"credential": "OD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-10-20",
"last_updated": "2009-10-16",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "WA",
"license": "OD00001687",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2020584",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Prosser, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2009; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.