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General NPI Number Information
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NPI Number | 1760888549
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Entity Type | Organization
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Legal Business Name | COLLIERVILLE VISION CENTER PLLC
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Dates
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Enumeration Date | 11/06/2014
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Last Update Date | 04/10/2015
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Provider Practice Location Address
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Address Line | 358 NEW BYHALIA RD
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City | COLLIERVILLE
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State | TN
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Zip | 38017-3743
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Country | US
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Telephone | 901-853-8180
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Fax | 901-853-1421
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Provider Business Mailing Address
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Address Line | 358 NEW BYHALIA RD
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City | COLLIERVILLE
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State | TN
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Zip | 38017-3743
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Country | US
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Telephone | 901-853-8180
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Fax | 901-853-1421
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Authorized Official
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Title or Position | OD/PRESIDENT
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Name | DR. BRANDON W WALLEY
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Credential | OD
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Telephone | 901-853-8180
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State | TN
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