JON PRESTON WILSON (NPI# 1760477731) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1760477731 |
| Entity Type | Individual |
| Full Name | JON PRESTON WILSON |
| Credential | O.D. |
| Practice Address |
165 W 200 N 71-7 Roosevelt UT 84066-2834 |
| Practice Telephone | 4357222981 |
| Practice Fax Number | 4357223732 |
| Mailing Telephone | 4357222981 |
| Mailing Fax Number | 4357223732 |
| Enumeration Date | 2005-09-15 |
| Last Update Date | 2008-06-18 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 152W00000X | Optometrist | 4944063-9934 | UT | Eye and Vision Services Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NTCA | 87041538400001 | 01 | |
| UT | OPTICARE | 1015 | 01 |
| PEHP | 67467 | 01 | |
| EYEMED | UT4063 | 01 | |
| UT | BCBS | 49440639900001 | 01 |
| UT | VALUCARE | 49440639900001 | 01 |
| UT | MEDICARE LEGACY NUMBER | 000012521 | 01 |
| VSP | 870444057 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750936282 | Jon Randolph Wilson | Acupuncturist | 3844b Keanu St, Honolulu, HI 96816-4263 | 2019-08-01 |
| 1407270499 | Jon Wilson | Speech-Language Pathologist | 1530 Hedington Cir, Lawrenceville, GA 30045-3718 | 2014-02-11 |
| 1871835843 | Jon Joseph Wilson | Pharmacist | 117 W Webster St, Cuba City, WI 53807-1100 | 2013-03-18 |
| 1417111329 | Jon Michael Wilson | Audiologist | 7375 W 52nd Ave Ste 310, Arvada, CO 80002-3748 | 2008-07-10 |
| 1023133030 | Jon Jeffrey Wilson | Family Medicine | 871 S Dade 201, Everton, MO 65646-7120 | 2007-03-20 |
| 1104970862 | Jon M Wilson Jr. | Podiatrist | 615 N Zaragoza Rd, El Paso, TX 79907-4773 | 2007-01-22 |
| 1447299219 | Jon David Wilson | Chiropractor | 10850 Lowell Ave, Overland Park, KS 66210-1613 | 2006-06-06 |
| 1407816218 | Jon Daniel Wilson | Pathology | 10810 Executive Center Dr Ste 100, Little Rock, AR 72211-4386 | 2006-03-24 |
| 1811529183 | Jon Kevin Wilson | Behavior Technician | 27777 Inkster Rd, Farmington Hills, MI 48334-5326 | 2020-02-05 |
| 1801435672 | Jon D. Wilson | Behavior Technician | 225 Cedar Hill St Ste 200, Marlborough, MA 01752-5900 | 2019-12-27 |
| Street Address |
165 W 200 N 71-7 |
| City | ROOSEVELT |
| State | UT |
| Zip Code | 84066-2834 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861487050 | Scott H Kowallis | Optometrist | 165 W 200 N, 71-7, Roosevelt, UT 84066-2834 | 2005-09-14 |
| 1942561311 | Jason Kowallis | Optometrist | 165 W 200 N, Roosevelt, UT 84066-2834 | 2012-06-01 |
| 1710973052 | Roosevelt Vision Clinic, PC | Optometrist | 165 W 200 N, 71-7, Roosevelt, UT 84066-2834 | 2005-09-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477075315 | Annemarie Rousseau | Registered Nurse | 250 West 300 North, Roosevelt, UT 84066 | 2017-07-12 |
| 1780036772 | Drew Gilley | Dentist | 375 E Lagoon St, Roosevelt, Ut 84066, Roosevelt, UT 84066 | 2016-07-01 |
| 1952758039 | Amanda Adams | Massage Therapist | 1151 East Hwy 40, Ballard, UT 84066 | 2016-05-19 |
| 1447624325 | Gregory George Page | Dentist | 209 West 200 North 71-2, Roosevelt, UT 84066 | 2015-11-16 |
| 1659785772 | Becky Ann Birch | Nurse Practitioner | 200 West 350 North, Ste 103, Roosevelt, UT 84066 | 2014-06-17 |
| 1760724280 | Novo Ranch LLC | Residential Treatment Facility, Emotionally Disturbed Children | 3549 W 1000 North, Roosevelt, UT 84066 | 2013-03-22 |
| 1508110040 | Uintah Basin Spine and Disc Center, PC | Rehabilitation Unit | 1151 East Highway 40, Roosevelt, UT 84066 | 2012-11-06 |
| 1184918682 | Alvaro Beltran | Dentist | Ave. Lopez Mateos 171-4, Nogales, SONORA 84066 | 2011-06-02 |
| 1255638367 | Cosme Cantu | Dentist | Blvd. El Greco #45 Int. J-14, Nogales, SONORA 84066 | 2011-02-25 |
| 1740482009 | Northeastern Utah Medical Group | Durable Medical Equipment & Medical Supplies | 210 W 300 N 75 3, Roosevelt, UT 84066 | 2007-05-31 |
| Find all providers in zip 84066 | ||||
| Taxonomy Code | 152W00000X |
| Grouping | Eye and Vision Services Providers |
| Classification | Optometrist |
| Doctors of optometry (ODs) are the primary health care professionals for the eye. Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures as well as identify related systemic conditions affecting the eye. An optometrist has completed pre-professional undergraduate education in a college or university and four years of professional education at a college of optometry, leading to the doctor of optometry (O.D.) degree. Some optometrists complete an optional residency in a specific area of practice. Optometrists are eye health care professionals state-licensed to diagnose and treat diseases and disorders of the eye and visual system. |
| Notes: Source: American Optometric Association (AOA), approved by the AOA’s Board of Trustees, June 21, 2005. [7/1/2006: definition modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952781262 | Cade John Kowallis | Optometrist | 165 W 200 N # 71-1, Roosevelt, UT 84066-2834 | 2015-06-02 |
| 1861487050 | Scott H Kowallis | Optometrist | 165 W 200 N, 71-7, Roosevelt, UT 84066-2834 | 2005-09-14 |
| 1942561311 | Jason Kowallis | Optometrist | 165 W 200 N, Roosevelt, UT 84066-2834 | 2012-06-01 |
| 1710973052 | Roosevelt Vision Clinic, PC | Optometrist | 165 W 200 N, 71-7, Roosevelt, UT 84066-2834 | 2005-09-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396351383 | National Vision Inc | Optometrist | 3857 West Campus View Drive, Suite 110, West Jordan, UT 84084 | 2020-09-16 |
| 1104443159 | National Vision Inc | Optometrist | 1917 W 1800 N Ste D1, Clinton, UT 84015-8558 | 2020-06-25 |
| 1295350247 | Victoria Nielsen | Optometrist | 4934 S Plymouth View Dr, Taylorsville, UT 84123-4204 | 2020-06-15 |
| 1124643226 | Desert View Eyecare | Optometrist | 15 South River Road St. 150, St. George, UT 84790 | 2020-06-15 |
| 1013532894 | Meagan Miles | Optometrist | 1752 W 400 N Apt B, Salt Lake City, UT 84116-3546 | 2020-06-08 |
| 1669096020 | Thomas Edward Clark | Optometrist | 3672 W South Jordan Pkwy Ste 103, South Jordan, UT 84009-7172 | 2020-06-02 |
| 1225651011 | Bethany Ruth Gillett | Optometrist | 3029 S Colt Plaza Dr Ste 1, West Valley City, UT 84128-4015 | 2020-05-27 |
| 1881217446 | Collin Robert Gray | Optometrist | 75 W State St, Lehi, UT 84043-1546 | 2020-05-18 |
| 1841820792 | Clifford Parker | Optometrist | 4283 Harrison Blvd, Ogden, UT 84403-3101 | 2020-01-20 |
| 1598303075 | Choice Eye Center, LLC | Optometrist | 12272 S 800 E Ste 100a, Draper, UT 84020-9776 | 2019-12-16 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.