Active NPI
Robert Allan Willson, O.D.
- Optometrist
- Maitland, FL
National Provider Identifier
1962486654
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- OPC1011
- Practice address
- 600 S Orlando Ave
Suite 300
Maitland, FL 32751-5660 - Phone
- (407) 647-2020
- Fax
- (407) 628-1216
- NPI assigned
- Dec 6, 2005
- 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 | OPC1011 | FL | Primary |
Addresses
Primary practice location
600 S Orlando Ave
Suite 300
Maitland, FL 32751-5660
Mailing address
600 S Orlando Ave
Suite 300
Maitland, FL 32751-5660
Phone (407) 647-2020
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 19256 | Other | FL | BCBS |
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 |
|---|---|---|---|
| 1011 | FL | MD | Anesthesiologist Assistant |
Networks
- Freedom Health HMO Network
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1133827200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1309219200000",
"number": "1962486654",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "600 S ORLANDO AVE",
"address_2": "SUITE 300",
"city": "MAITLAND",
"state": "FL",
"postal_code": "327515660",
"telephone_number": "407-647-2020",
"fax_number": "407-628-1216"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "600 S ORLANDO AVE",
"address_2": "SUITE 300",
"city": "MAITLAND",
"state": "FL",
"postal_code": "327515660",
"telephone_number": "407-647-2020",
"fax_number": "407-628-1216"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLSON",
"first_name": "ROBERT",
"middle_name": "ALLAN",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-12-06",
"last_updated": "2011-06-28",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "FL",
"license": "OPC1011",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "19256",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Maitland, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.