Collierville Vision Center PLLC

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

COLLIERVILLE VISION CENTER PLLC

Practice address

358 New Byhalia Rd
Collierville, TN 38017-3743

Phone

(901) 853-8180

Fax

(901) 853-1421

NPI assigned

Nov 6, 2014

Last updated

Apr 10, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Brandon W Walley, ODNPI 1508027277

Title

OD/President

Phone

(901) 853-8180

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Brandon W Walley, O.D.

  • Optometrist
  • Collierville, TN
  • NPI 1508027277
  Medicare reassignment NPD Authorized official
• Woodrow Wilson Justice, O.D.

  • Optometrist
  • Collierville, TN
  • NPI 1619916723
  NPD (past)
• Phillip Adam Gray, O. D.

  • Optometrist
  • Iuka, MS
  • NPI 1518980051
  NPD (past)

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

{
    "created_epoch": "1415232000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1428624000000",
    "number": "1760888549",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "358 NEW BYHALIA RD",
            "city": "COLLIERVILLE",
            "state": "TN",
            "postal_code": "380173743",
            "telephone_number": "901-853-8180",
            "fax_number": "901-853-1421"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "358 NEW BYHALIA RD",
            "city": "COLLIERVILLE",
            "state": "TN",
            "postal_code": "380173743",
            "telephone_number": "901-853-8180",
            "fax_number": "901-853-1421"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLLIERVILLE VISION CENTER PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-11-06",
        "last_updated": "2015-04-10",
        "status": "A",
        "authorized_official_last_name": "WALLEY",
        "authorized_official_first_name": "BRANDON",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "OD/PRESIDENT",
        "authorized_official_telephone_number": "901-853-8180",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Collierville Medical Assoc Inc
• Collierville Medical Specialists
• Collierville Nursing and Rehabilitation LLC (Collierville Nursing and Rehabilitation)
• Collierville Orthopedics and
• Collierville Pediatrics, LLC
• Comfort Care Transit Solutions LLC
• Comfort Home Sleep Test Corp
• Core Care Assistance LLC
• Core Psychiatry Inc.
• Corp. of Collierville (Town of Collierville)

• Optometrist in Collierville, TN
• Providers in Collierville, TN by specialty
• Optometrist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.