Individual
DR. BRANDON W WALLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
358 NEW BYHALIA RD, SUITE 3, COLLIERVILLE, TN 38017-3743
(901) 853-8180
(901) 853-1421
Mailing address
358 NEW BYHALIA RD, SUITE 3, COLLIERVILLE, TN 38017-3743
(901) 853-8180
(901) 853-1421
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
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