Healthcare Provider Details

I. General information

NPI: 1144609645
Provider Name (Legal Business Name): WELL CHILD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2015
Last Update Date: 06/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 NEW YORK ST
MEMPHIS TN
38104-5536
US

IV. Provider business mailing address

650 NEW YORK ST
MEMPHIS TN
38104-5536
US

V. Phone/Fax

Practice location:
  • Phone: 901-728-5858
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: KAREN J PEASE
Title or Position: CEO
Credential:
Phone: 901-728-5858