{"npi":"1871593764","type":"NPI-1","status":"active","name":{"display":"Carmen Wilson MD","other":[],"first":"CARMEN","last":"WILSON","middle":"JOSEFA","credential":"MD"},"specialty":{"primary_taxonomy":"207W00000X","primary_taxonomy_description":"Ophthalmology Physician","slug":"ophthalmology-physician","schema_org_specialty":null,"all":[{"code":"207W00000X","description":"Ophthalmology Physician","primary":false,"state":"GA","license":"044609"},{"code":"207W00000X","description":"Ophthalmology Physician","primary":true,"state":"FL","license":"ME140321"}]},"addresses":[{"purpose":"LOCATION","street_1":"820 W SUGARLAND HWY","city":"CLEWISTON","state":"FL","postal_code":"33440","country_code":"US","phone":"9417922020"},{"purpose":"MAILING","street_1":"PO BOX 162264","city":"ALTAMONTE SPRINGS","state":"FL","postal_code":"327162264","country_code":"US","phone":"9417922020"}],"license":{"state":"FL","number":"ME140321"},"identifiers":[{"type_code":"05","label":"Medicaid","value":"000791249B","state":"GA","issuer":null}],"pecos":{"enrolled_at":"2026-05-09T10:41:39.028268+00:00","enrollments":[{"enrlmt_id":"I20190517001550","type_code":"14-18","type_desc":"PRACTITIONER - OPHTHALMOLOGY","state":"FL","pac_id":"8325062284"}]},"enumeration_date":"2005-07-21","last_updated":"2024-08-05","_meta":{"source":"NPPES","snapshot_date":"2024-08-05","doc_url":"https://findmynpi.com/api"}}