Active NPI
Channing Wells, O.D.
- Optometrist
- Jackson, MS
National Provider Identifier
1326438706
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 916
- Practice address
- 2711 Greenway Dr
Suite a
Jackson, MS 39204-3304 - Phone
- (601) 922-9300
- Fax
- (601) 922-6312
- NPI assigned
- Jan 23, 2015
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 916 | MS | Primary |
Addresses
Primary practice location
2711 Greenway Dr
Suite a
Jackson, MS 39204-3304
Mailing address
2711 Greenway Dr
Suite a
Jackson, MS 39204-3304
Phone (601) 922-9300
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MS
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20180928001237 | MS | Practitioner - Optometry | 7618228768 | Reassigns benefits to 1 organization |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 916 | MS | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wells Vision LLC | Optometrist | Current | Accepting new patients |
| Mississippi Vision Center | Optometrist | Past | Accepting new patients |
Locations
527 Lake St
Hazlehurst, MS 39083
Phone (601) 894-1476
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Optometrist
- Jackson, MS
- NPI 1235553322
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1421971200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1421971200000",
"number": "1326438706",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2711 GREENWAY DR",
"address_2": "SUITE A",
"city": "JACKSON",
"state": "MS",
"postal_code": "392043304",
"telephone_number": "601-922-9300",
"fax_number": "601-922-6312"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2711 GREENWAY DR",
"address_2": "SUITE A",
"city": "JACKSON",
"state": "MS",
"postal_code": "392043304",
"telephone_number": "601-922-9300",
"fax_number": "601-922-6312"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WELLS",
"first_name": "CHANNING",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-01-23",
"last_updated": "2015-01-23",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "MS",
"license": "916",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jackson, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2015; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.