Healthcare Provider Details

I. General information

NPI: 1346392347
Provider Name (Legal Business Name): 2001 VISION CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 08/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3142 THOMAS ST
MEMPHIS TN
38127-6003
US

IV. Provider business mailing address

3142 THOMAS ST
MEMPHIS TN
38127-6003
US

V. Phone/Fax

Practice location:
  • Phone: 901-353-6222
  • Fax: 901-353-3688
Mailing address:
  • Phone: 901-353-6222
  • Fax: 901-353-3688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTN0757
License Number StateTN

VIII. Authorized Official

Name: BEVERLY B ROGERS
Title or Position: CORPORATE SECRETARY
Credential:
Phone: 901-363-2001