Healthcare Provider Details

I. General information

NPI: 1851423669
Provider Name (Legal Business Name): TOTAL EYE CARE P A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 09/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6060 PRIMACY PKWY SUITE 200
MEMPHIS TN
38119-5745
US

IV. Provider business mailing address

6060 PRIMACY PKWY SUITE 200
MEMPHIS TN
38119-5745
US

V. Phone/Fax

Practice location:
  • Phone: 901-761-4620
  • Fax: 901-761-3072
Mailing address:
  • Phone: 901-761-4620
  • Fax: 901-761-3072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID G EVANS
Title or Position: OWNER
Credential:
Phone: 901-761-4620