MEDICARE: DR. DAVID KEITH TALLEY O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	1797	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1797	OTHER	TN	OD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1982697058
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID KEITH TALLEY O.D.

Provider Business Mailing Address
First Line	:	2070 WHITNEY AVE
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38127-9014
Country	:	US
Telephone Number	:	901-357-0371
Fax Number	:	901-358-7574

Provider Business Practice Location Address
First Line	:	2070 WHITNEY AVE
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38127-9014
Country	:	US
Telephone Number	:	901-357-0371
Fax Number	:	901-358-7574

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/24/2005
Last Update Date	:	03/07/2023

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