Wells Vision LLC

Primary specialty

OptometristTaxonomy code 152W00000X

License

916 Issued in MS

Legal business name

WELLS VISION LLC

Practice address

960 Brookway Blvd
Brookhaven, MS 39601-2644

Phone

(601) 823-4494

NPI assigned

Feb 1, 2018

Organization subpart

No

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

Authorized official

Name

Dr. Channing Wells, ODNPI 1326438706

Title

Optometrist

Phone

(601) 946-5492

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MS

Enrollment records 1

Practitioners 1

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

• Channing Wells, O.D.

  • Optometrist
  • Jackson, MS
  • NPI 1326438706
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1517443200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1517443200000",
    "number": "1164920484",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1390 MOSES RD",
            "city": "RAYMOND",
            "state": "MS",
            "postal_code": "391548943",
            "telephone_number": "601-946-5492"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "960 BROOKWAY BLVD",
            "city": "BROOKHAVEN",
            "state": "MS",
            "postal_code": "396012644",
            "telephone_number": "601-823-4494"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLS VISION LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-02-01",
        "last_updated": "2018-02-01",
        "status": "A",
        "authorized_official_last_name": "WELLS",
        "authorized_official_first_name": "CHANNING",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "601-946-5492",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "MS",
            "license": "916",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04802528",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Loren Watts Williams, MSN, APRN, FNP-C
• Terry Catchings Williams, NP-C
• Katressia Antwanette Wilson

• Optometrist in Brookhaven, MS
• Providers in Brookhaven, MS by specialty
• Optometrist in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.