Individual provider Active NPI

Ashley Danielle Wallace-Tucker, O.D.

  • Optometrist
  • Houston, TX
National Provider Identifier
1407169824
Registry record updated May 17, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
7618 Issued in TX
Practice address
4401 Martin Luther King Blvd
Houston, TX 77204-2020
Phone
(713) 743-2020
Fax
(713) 743-0963
NPI assigned
Jul 15, 2010
Last updated
May 17, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 17, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 7618TG TX
Optometrist 152W00000X 7618T TX
Optometrist 152W00000X 7618 TX Primary

Addresses

Primary practice location

4401 Martin Luther King Blvd
Houston, TX 77204-2020

Mailing address

4401 Martin Luther King Blvd
Houston, TX 77204-2020
Phone (713) 743-2020

Other identifiers 2

IdentifierTypeStateIssuer
214787801MedicaidTX
112409104MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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 1

Enrollment IDStateProvider typePAC IDDetails
I20100824000411 TX Practitioner - Optometry 9133243462 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
University of Houston - College of Optometry, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Neurosensory Center of Bellaire PAGroup PAC ID 4385785088, 6 clinicians

Practice addresses (Care Compare)

5001 Bissonnet St
Suite 107
Bellaire, TX 77401-4015
Phone (713) 664-8087

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
7618TTXMDOptometrist
7618TGTXMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
University of Houston System Optometrist Current Accepting new patients
University of Houston CurrentSince Jul 8, 2010 Accepting new patients
Neurosensory Center of Bellaire PA Optometrist CurrentSince Dec 1, 2013 Accepting new patients
University of Houston System CurrentSince Jul 8, 2010 Accepting new patients
Bellaire Family Eye Care PA Optometrist Past Accepting new patients

Locations

5001 Bissonnet St
Ste 107
Bellaire, TX 77401
Phone (713) 664-8087

190 Heights Blvd
Houston, TX 77007
Phone (713) 527-8480

4401 Martin Luther King Blvd
Houston, TX 77204
Phone (713) 743-1921

505 J Davis Armistead Bldg
Houston, TX 77204
Phone (713) 743-1921

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1279152000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1652745600000",
    "number": "1407169824",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4401 MARTIN LUTHER KING BLVD",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "772042020",
            "telephone_number": "713-743-2020",
            "fax_number": "713-743-0963"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4401 MARTIN LUTHER KING BLVD",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "772042020",
            "telephone_number": "713-743-2020",
            "fax_number": "713-743-0963"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE-TUCKER",
        "first_name": "ASHLEY",
        "middle_name": "DANIELLE",
        "name_prefix": "Mrs.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-07-15",
        "last_updated": "2022-05-17",
        "certification_date": "2022-05-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TX",
            "license": "7618TG",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TX",
            "license": "7618T",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TX",
            "license": "7618",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "214787801",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "112409104",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Houston, TX

Sources for this page

Verify at the official NPI Registry.