Marissa Brooke Wall, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

OPT34197 Issued in CA

Practice address

1011 Sylvan Ave
Modesto, CA 95350-1692

Phone

(209) 575-2020

NPI assigned

Sep 12, 2018

Last updated

Dec 22, 2021By 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 TX, CA2 enrollments

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 2

Specialty

Optometry

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Valley View OptometryGroup PAC ID 7911268297, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Valley View Optometry

  • Optometrist
  • Oakdale, CA
  • NPI 1306345640
  Medicare reassignment Care Compare group NPD
• Fifth Optometric Care of California

  • Optometrist
  • San Jose, CA
  • NPI 1215627914
  Medicare reassignment NPD
• Sylvan Eye Associates, a Medical Corporation

  • Ophthalmology Physician
  • Modesto, CA
  • NPI 1740279207

  Optometrist

  Medicare reassignment NPD
• Kayenta Alternative Rural Hospital

  • General Acute Care Hospital
  • Kayenta, AZ
  • NPI 1174692529

  TX

  Medicare reassignment NPD
• Fifth Optometric Care of California

  dba Taft Eye Care Optometric Center

  • Optometrist
  • Taft, CA
  • NPI 1699504746
  NPD
• Central Valley Eye Medical Group Inc.

  • Ophthalmology Physician
  • Stockton, CA
  • NPI 1609975366

  Optometrist

  NPD (past)
• Fifth Optometric Care of California

  dba Sylvan Eye Associates

  • Optometrist
  • Modesto, CA
  • NPI 1548018633
  NPD (past)
• Sylvan Eye Associates

  • Ophthalmology Physician
  • Modesto, CA
  • NPI 1487839379
  NPD (past)
• Kayenta Alternative Rural Hospital

  dba Inscription House Health Center

  • General Acute Care Hospital
  • Tonalea, AZ
  • NPI 1740359108
  NPD (past)

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

{
    "created_epoch": "1536710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640131200000",
    "number": "1265915615",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1011 SYLVAN AVE",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953501692",
            "telephone_number": "209-575-2020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1011 SYLVAN AVE",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953501692",
            "telephone_number": "209-575-2020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALL",
        "first_name": "MARISSA",
        "middle_name": "BROOKE",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-09-12",
        "last_updated": "2021-12-22",
        "certification_date": "2021-12-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "OPT34197",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Graciela Walker
• John Allan Walker, MD
• Shellie Walker
• Tamira Walker
• Amanda Wall
• John Wallace
• Kevin Wallace
• Kevin Wallace, ND
• Sasha Wallace
• Thomas M Wallace, M.D.

• Optometrist in Modesto, CA
• Providers in Modesto, CA by specialty
• Optometrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2021; 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.