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General NPI Number Information
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NPI Number | 1477721256
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Entity Type | Organization
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Legal Business Name | ST FRANCIS OPTICAL DISPENSARY
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Dates
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Enumeration Date | 02/14/2008
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Last Update Date | 03/18/2008
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Provider Practice Location Address
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Address Line | 6005 PARK AVE
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City | MEMPHIS
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State | TN
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Zip | 38119-5202
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Country | US
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Telephone | 901-761-2390
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Fax |
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Provider Business Mailing Address
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Address Line | 6005 PARK AVE ST FRANCIS OPTICAL DISPENSARY
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City | MEMPHIS
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State | TN
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Zip | 38119-5202
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Country | US
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Telephone | 901-761-2390
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | MR. LOUIS DANIEL PAGANO SR.
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Credential | OPTICIAN
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Telephone | 901-761-2390
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number | 294
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License Number State | TN
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