MEDICARE: VRF EYE SPECIALTY GROUP, PLC

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	207W00000X	Ophthalmology Physician
2	152W00000X	Optometrist

General Provider Information

NPI Number	:	1497378004
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VRF EYE SPECIALTY GROUP, PLC

Provider Business Mailing Address
First Line	:	PO BOX 22510
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39225-2510
Country	:	US
Telephone Number	:	901-685-2200
Fax Number	:	901-255-5631

Provider Business Practice Location Address
First Line	:	1028 N MISSOURI ST STE 1
Second Line	:
City	:	WEST MEMPHIS
State	:	AR
Zip	:	72301-2600
Country	:	US
Telephone Number	:	870-735-8466
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	THOMAS BROWN
Credential	:
Telephone Number	:	901-685-2200

Provider Enumeration Date	:	05/19/2020
Last Update Date	:	05/19/2020

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