MEDICARE: 2001 VISION CENTER PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	TN0757	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	1841373727	OTHER		NPI
5	1407860679	OTHER	TN	NPI
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	1104206622	OTHER	TN	NPI
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346392347
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	2001 VISION CENTER PC

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

Provider Business Practice Location Address
First Line	:	3142 THOMAS ST
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38127-6003
Country	:	US
Telephone Number	:	901-353-6222
Fax Number	:	901-353-3688

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

Provider Enumeration Date	:	01/18/2007
Last Update Date	:	08/14/2015

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