Vanessa Wall, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

2652 Issued in AR

Practice address

623 E Matthews Ave
Jonesboro, AR 72401-3145

Phone

(870) 932-2211

Fax

(870) 972-5152

NPI assigned

Jul 23, 2010

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 AR

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

Specialty

Optometry

Education

Southern College of Optometry, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Southern Eye Associates LTDGroup PAC ID 4688576739, 8 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 and National Provider Directory roles.

• Southern Eye Associates LTD

  • Ophthalmology Physician
  • Jonesboro, AR
  • NPI 1669486528

  Optometrist

  Medicare reassignment Care Compare group NPD
• Southern Eye Associates LTD

  • Optometrist
  • Paragould, AR
  • NPI 1750478186
  NPD

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

{
    "created_epoch": "1279843200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1342742400000",
    "number": "1417260019",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "623 E MATTHEWS AVE",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "724013145",
            "telephone_number": "870-932-2211",
            "fax_number": "870-972-5152"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "623 E MATTHEWS AVE",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "724013145",
            "telephone_number": "870-932-2211",
            "fax_number": "870-972-5152"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALL",
        "first_name": "VANESSA",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-07-23",
        "last_updated": "2012-07-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "AR",
            "license": "2652",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shawn Walker
• Tashanescii Walker, LPC
• Tonya Walker, LPN
• Jason Walkup, LMSW
• Walkwell PLLC
• Aaron Jack Wallace, MD
• Anna Wallace
• Aubrey Wallace
• Brooke Wallace, COTA/L
• Feliece Wallace

• Optometrist in Jonesboro, AR
• Providers in Jonesboro, AR by specialty
• Optometrist in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2012; 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.