Individual
DR. BRANDON W WALLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2811
TN
152W00000X
Optometrist
805
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11861175
CAQH
—
01
—
2811
TN LICENSE
TN
01
—
805
MS LICENSE
MS
Enumeration date
06/24/2008
Last updated
11/19/2014
Update your record
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