1346392347 NPI number — 2001 VISION CENTER PC

Table of content: (NPI 1346392347)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346392347 NPI number — 2001 VISION CENTER PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
2001 VISION CENTER PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1346392347
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/14/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3142 THOMAS ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MEMPHIS
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38127-6003
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
901-353-6222
Provider Business Mailing Address Fax Number:
901-353-3688

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3142 THOMAS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MEMPHIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38127-6003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-353-6222
Provider Business Practice Location Address Fax Number:
901-353-3688
Provider Enumeration Date:
01/18/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ROGERS
Authorized Official First Name:
BEVERLY
Authorized Official Middle Name:
B
Authorized Official Title or Position:
CORPORATE SECRETARY
Authorized Official Telephone Number:
901-363-2001

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  TN0757 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4315257 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: Q014312 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: Q008443 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1841373727 . This is a "NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1407860679 . This is a "NPI" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3023011 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1104206622 . This is a "NPI" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: Q008437 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3595608 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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