NPIMap

Organization Active NPI

Charles R Wilder OD PC

  • Case Management Agency
  • Romulus, MI
National Provider Identifier
1982996203
Registry record updated May 4, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Case Management AgencyTaxonomy code 251B00000X
License
4901002266 Issued in MI
Legal business name
CHARLES R WILDER OD PC
Practice address
15401 Harriet St
Romulus, MI 48174-3069
Phone
(734) 782-7200
Fax
(734) 229-9558
NPI assigned
May 4, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 4, 2011

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

Authorized official

Name
Dr. Charles Romeo Wilder II, OD
Title
President
Phone
(734) 782-7200

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Case Management Agency 251B00000X 4901002266 MI Primary

Addresses

Primary practice location

15401 Harriet St
Romulus, MI 48174-3069

Mailing address

15401 Harriet St
Romulus, MI 48174-3069
Phone (734) 782-7200

Other identifiers 1

IdentifierTypeStateIssuer
5006929MedicaidMI

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1304467200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1304467200000",
    "number": "1982996203",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15401 HARRIET ST",
            "city": "ROMULUS",
            "state": "MI",
            "postal_code": "481743069",
            "telephone_number": "734-782-7200",
            "fax_number": "734-229-9558"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15401 HARRIET ST",
            "city": "ROMULUS",
            "state": "MI",
            "postal_code": "481743069",
            "telephone_number": "734-782-7200",
            "fax_number": "734-229-9558"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHARLES R WILDER OD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-04",
        "last_updated": "2011-05-04",
        "status": "A",
        "authorized_official_last_name": "WILDER",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "ROMEO",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "734-782-7200",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "II",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": "MI",
            "license": "4901002266",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5006929",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Romulus, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 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.

Verify at the official NPI Registry.