W. Berry Maultsby, Jr., O.D., P.C.

Primary specialty

OptometristTaxonomy code 152W00000X

License

0618000688 Issued in VA

Legal business name

W. BERRY MAULTSBY, JR., O.D., P.C.

Practice address

413 Mt. Cross Road
Suite 203
Danville, VA 24540

Phone

(434) 791-3937

Fax

(434) 791-2468

NPI assigned

May 26, 2009

Last updated

Jun 2, 2009By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Wallace Berry Maultsby Jr., O.D.

Title

Optometrist

Phone

(434) 791-3937

Specialties & licenses 1

Addresses

Other identifiers 2

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

{
    "created_epoch": "1243296000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1243900800000",
    "number": "1134354897",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "413 MT. CROSS ROAD",
            "address_2": "SUITE 203",
            "city": "DANVILLE",
            "state": "VA",
            "postal_code": "24540",
            "telephone_number": "434-791-3937",
            "fax_number": "434-791-2468"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "413 MT. CROSS ROAD",
            "address_2": "SUITE 203",
            "city": "DANVILLE",
            "state": "VA",
            "postal_code": "24540",
            "telephone_number": "434-791-3937",
            "fax_number": "434-791-2468"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "W. BERRY MAULTSBY, JR., O.D., P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-05-26",
        "last_updated": "2009-06-02",
        "status": "A",
        "authorized_official_last_name": "MAULTSBY",
        "authorized_official_first_name": "WALLACE",
        "authorized_official_middle_name": "BERRY",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "434-791-3937",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "VA",
            "license": "0618000688",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010337861",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "465270",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Fedena C Wade, LCSW
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• Wal-Mart Stores East LP (Walmart Pharmacy 10-5829)

• Optometrist in Danville, VA
• Providers in Danville, VA by specialty
• Optometrist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2009; 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.