Taylor Grace Tackett, DOCTOR OF OPTOMETRY

Primary specialty

OptometristTaxonomy code 152W00000X

License

S-F21 Issued in AL

Practice address

14378 Highway 43
Russellville, AL 35653-2568

Phone

(256) 332-1355

NPI assigned

May 22, 2023

Last updated

Jun 7, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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 AL

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

Other, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Campbell Vision Center, Inc.Group PAC ID 6608876495, 3 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Networks

• AL HMO D-SNP
• devoted network organization-14bfd35d-d818-4696-813b-340339e464ef
• TN PPO C-SNP
• AL HMO
• devoted network organization-25ba88d3-d0a6-4213-84f1-eef6f2b59f68
• devoted network organization-d5084670-562f-408b-b100-22a1a4ef4d82
• TN PPO

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.

• Campbell Vision Center, Inc.

  • Optometrist
  • Russellville, AL
  • NPI 1649371550
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1684713600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686096000000",
    "number": "1003508797",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7087 HIGHWAY 524",
            "city": "RUSSELLVILLE",
            "state": "AL",
            "postal_code": "356536552",
            "telephone_number": "256-460-5793"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14378 HIGHWAY 43",
            "city": "RUSSELLVILLE",
            "state": "AL",
            "postal_code": "356532568",
            "telephone_number": "256-332-1355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TACKETT",
        "first_name": "TAYLOR",
        "middle_name": "GRACE",
        "name_prefix": "Dr.",
        "credential": "DOCTOR OF OPTOMETRY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-05-22",
        "last_updated": "2023-06-07",
        "certification_date": "2023-06-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "AL",
            "license": "S-F21",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kaitlyn Stewart
• Janice Stidham
• Lauren N Stirling, O.D.
• Nina J Stowe, CRNP
• Tabatha Michelle Sutherland Marbutt, MSN, APRN, FNP-C
• The Drug Shop LLC
• Letanndra Thompson, LMSW
• Glenda Tompkins
• Laquita Underwood
• Urgent Care of Russellville, LLC

• Optometrist in Russellville, AL
• Providers in Russellville, AL by specialty
• Optometrist in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2023; 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.