Provider Demographics
NPI:1982697058
Name:TALLEY, DAVID KEITH (OD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:KEITH
Last Name:TALLEY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2070 WHITNEY AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38127-9014
Mailing Address - Country:US
Mailing Address - Phone:901-357-0371
Mailing Address - Fax:901-358-7574
Practice Address - Street 1:2070 WHITNEY AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38127-9014
Practice Address - Country:US
Practice Address - Phone:901-357-0371
Practice Address - Fax:901-358-7574
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1797152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1797OtherOD
TN3941896Medicaid
MT0167088OtherDEA
MT0167088OtherDEA
TN3941896Medicare ID - Type Unspecified
TN1797OtherOD