Provider Demographics
NPI:1780876862
Name:MAYES, WESLEY THOMAS (OD)
Entity type:Individual
Prefix:DR
First Name:WESLEY
Middle Name:THOMAS
Last Name:MAYES
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 1:9050 UNIVERSITY PKWY
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-5524
Mailing Address - Country:US
Mailing Address - Phone:850-266-7500
Mailing Address - Fax:
Practice Address - Street 1:9050 UNIVERSITY PKWY
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-5524
Practice Address - Country:US
Practice Address - Phone:850-266-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-13
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 4224152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2799677Medicaid
FL36139OtherBLUE CROSS AND BLUE SHIELD OF FLORIDA
AL20ZZMedicare PIN