NPIMap

Organization Active NPI

Corey Glenn Persons

  • Optometrist
  • Jackson, TN
National Provider Identifier
1124491246
Registry record updated May 18, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
1779 Issued in TN
Legal business name
COREY GLENN PERSONS
Practice address
1239 Vann Dr
Jackson, TN 38305-4918
Phone
(731) 256-7911
Fax
(731) 664-5243
NPI assigned
Nov 11, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 18, 2021

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

Authorized official

Name
Dr. Corey Glenn Persons, O.D.
Title
Owner
Phone
(731) 256-7911

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 1779 TN Primary

Addresses

Primary practice location

1239 Vann Dr
Jackson, TN 38305-4918

Mailing address

1239 Vann Dr
Jackson, TN 38305-4918
Phone (731) 256-7911

Other identifiers 2

IdentifierTypeStateIssuer
Q020091MedicaidTN
Q020087MedicaidTN

Other names 1

  • Dr. Corey Persons& Associates Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1447200000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1621296000000",
    "number": "1124491246",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1239 VANN DR",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383054918",
            "telephone_number": "731-256-7911",
            "fax_number": "731-664-5243"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1239 VANN DR",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383054918",
            "telephone_number": "731-256-7911",
            "fax_number": "731-664-5243"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COREY GLENN PERSONS",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-11-11",
        "last_updated": "2021-05-18",
        "certification_date": "2021-05-18",
        "status": "A",
        "authorized_official_last_name": "PERSONS",
        "authorized_official_first_name": "COREY",
        "authorized_official_middle_name": "GLENN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "731-256-7911",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "TN",
            "license": "1779",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q020091",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q020087",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dr. Corey Persons& Associates",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Dr. Corey Persons& Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jackson, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2021; 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.