Charleston Vision Center PA

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

CHARLESTON VISION CENTER PA

Practice address

288 W Main St
Charleston, MS 38921-2229

Phone

(662) 647-8707

Fax

(662) 647-8706

NPI assigned

Mar 13, 2013

Last updated

Feb 1, 2021By 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

Ashleigh Tackett

Title

Clinic Coordinator

Phone

(662) 647-8707

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MS

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 4

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.

• Michael Edward Obrien, O.D.

  • Optometrist
  • Southaven, MS
  • NPI 1306925029
  Medicare reassignment Care Compare group NPD
• Jonathan William Wilson, O.D.

  • Optometrist
  • Southaven, MS
  • NPI 1881738532
  Medicare reassignment Care Compare group NPD
• Ty Smith, OD

  • Optometrist
  • Collierville, TN
  • NPI 1992282529

  MS

  Medicare reassignment Care Compare group NPD
• David V Obrien, OD

  • Optometrist
  • Charleston, MS
  • NPI 1891977393
  NPD (past)

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

{
    "created_epoch": "1363132800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1612137600000",
    "number": "1932440138",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1890 GOODMAN RD E",
            "address_2": "SUITE 100",
            "city": "SOUTHAVEN",
            "state": "MS",
            "postal_code": "386719504"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "288 W MAIN ST",
            "city": "CHARLESTON",
            "state": "MS",
            "postal_code": "389212229",
            "telephone_number": "662-647-8707",
            "fax_number": "662-647-8706"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHARLESTON VISION CENTER PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-03-13",
        "last_updated": "2021-02-01",
        "certification_date": "2021-02-01",
        "status": "A",
        "authorized_official_last_name": "TACKETT",
        "authorized_official_first_name": "ASHLEIGH",
        "authorized_official_title_or_position": "CLINIC COORDINATOR",
        "authorized_official_telephone_number": "662-647-8707"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MS",
            "license": "722",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MS",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Victor Glenn Bailey Jr., PHARMACIST
• Better Days at Home Care, LLC
• Sharon Bradley
• Robert L. Carter, MD
• Charleston Clinic
• Marijo D Cox, MSW
• Lasuna M Curry, MSW
• Delta Med South, Inc.
• East Tallahatchie Schools
• Kelsey Marter Faulkner

• Optometrist in Charleston, MS
• Providers in Charleston, MS by specialty
• Optometrist in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.