Active NPI
Brianna Willis, O.D.
- Optometrist
- Beaumont, TX
National Provider Identifier
1467979328
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 9268T
- Practice address
- 5854 Eastex Fwy
Beaumont, TX 77708-4824 - Phone
- (409) 899-1177
- NPI assigned
- Aug 23, 2017
- Sex
- Female
- Sole proprietor
- No
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 | 9268T | TX | Primary |
Addresses
Primary practice location
5854 Eastex Fwy
Beaumont, TX 77708-4824
Mailing address
930 Heights Blvd
Houston, TX 77008-6912
Phone (713) 492-5003
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366555229 | Medicaid | TX |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9268 | TX | MD | Behavioral Analyst |
| 9268T | TX | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1503446400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1503446400000",
"number": "1467979328",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "930 HEIGHTS BLVD",
"city": "HOUSTON",
"state": "TX",
"postal_code": "770086912",
"telephone_number": "713-492-5003"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5854 EASTEX FWY",
"city": "BEAUMONT",
"state": "TX",
"postal_code": "777084824",
"telephone_number": "409-899-1177"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLIS",
"first_name": "BRIANNA",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-08-23",
"last_updated": "2017-08-23",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "TX",
"license": "9268T",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1366555229",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Beaumont, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.