Shae Wilson

Primary specialty

OptometristTaxonomy code 152W00000X

License

2407DT Issued in KY

Practice address

1407 N Race St
Glasgow, KY 42141-3490

Phone

(270) 651-6652

NPI assigned

Apr 12, 2024

Last updated

Jul 8, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in KY

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

Specialty

Optometry

Education

Southern California College of Optometry, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Sage Peak Eye Care PLLCGroup PAC ID 1759805047, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Sage Peak Eye Care PLLC

  • Optometrist
  • Glasgow, KY
  • NPI 1922814243
  Medicare reassignment Care Compare group NPD Authorized official
• Eye Care of Southern Kentucky, PSC

  • Eyewear Supplier
  • Glasgow, KY
  • NPI 1639325624
  Medicare reassignment NPD

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

{
    "created_epoch": "1712880000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720396800000",
    "number": "1972357382",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "476 TIMBER RIDGE RD",
            "city": "LOST CREEK",
            "state": "WV",
            "postal_code": "263857227"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1407 N RACE ST",
            "city": "GLASGOW",
            "state": "KY",
            "postal_code": "421413490",
            "telephone_number": "270-651-6652"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "SHAE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-04-12",
        "last_updated": "2024-07-08",
        "certification_date": "2024-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "KY",
            "license": "2407DT",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wilson ENT PSC
• Jeffrey Lee Wilson, M.D.
• Michelle A Wilson, APRN
• Nakeisha Brooke Wilson, LCSW
• Nicole Wilson
• Carl Thomas Wimmer, C.R.N.A
• Spencer Broady Witcher, MD
• Anita Denise Witt, MAE, PLE, DI
• Lauren Renae Witt
• Karen S. Witty, D.I./IECE/MAE

• Optometrist in Glasgow, KY
• Providers in Glasgow, KY by specialty
• Optometrist in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2024; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.