Healthcare Provider Details

I. General information

NPI: 1487868527
Provider Name (Legal Business Name): MEMPHIS REFRACTIVE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

795 RIDGE LAKE BLVD STE. 103
MEMPHIS TN
38120-9475
US

IV. Provider business mailing address

16305 SWINGLEY RIDGE RD STE. 300
CHESTERFIELD MO
63017-1777
US

V. Phone/Fax

Practice location:
  • Phone: 901-683-7255
  • Fax:
Mailing address:
  • Phone: 636-534-2300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BRIAN L ANDREW
Title or Position: SECRETARY
Credential:
Phone: 636-534-2300