Healthcare Provider Details

I. General information

NPI: 1609869866
Provider Name (Legal Business Name): LEROY NORTON JR. OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4557 MILLBRANCH RD LEROY NORTON JR OD
MEMPHIS TN
38116
US

IV. Provider business mailing address

4557 MILLBRANCH RD
MEMPHIS TN
38116
US

V. Phone/Fax

Practice location:
  • Phone: 901-346-8222
  • Fax: 901-346-8205
Mailing address:
  • Phone: 901-722-3250
  • Fax: 901-722-3347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1221
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: