Bryley Jae Banks, OD
Individual provider Active NPI Optometrist · Fort Smith, AR
NPI 1124864111 · NPPES record last updated Jul 8, 2024
Key facts
- NPI
- 1124864111
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 2882 (AR)
- Practice address
- 1021 S Waldron Rd
Fort Smith, AR 72903-2549 - Phone
- (417) 629-0505
- NPI assigned
- Jul 8, 2024
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Optometry
- Education
- Other, 2024
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Arkansas Vision Development Center PA
Practice addresses (Care Compare)
1021 S Waldron Rd
Fort Smith, AR 72903-2549
Phone (479) 478-8860
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AR
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240830002693 | AR | Practitioner - Optometry | 9032658257 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2882 | AR | MD | Optometrist |
| 2024020536 | MO | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Arkansas Vision Development Center PA | Current |
Accepting new patients |
Locations
1021 S Waldron Rd
Fort Smith, AR 72903
Phone (479) 478-8860
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 2024020536 | MO | |
| Optometrist | 152W00000X | 2882 | AR | Yes |
Addresses
Primary practice location
1021 S Waldron Rd
Fort Smith, AR 72903-2549
Mailing address
1021 S Waldron Rd
Fort Smith, AR 72903-2549
Phone (479) 478-8860
Other providers in Fort Smith, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.