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General NPI Number Information
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NPI Number | 1730309675
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Entity Type | Organization
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Legal Business Name | EYECARE CENTER OF MEMPHIS, INC.
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Dates
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Enumeration Date | 04/25/2007
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Last Update Date | 08/13/2008
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Provider Practice Location Address
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Address Line | 2705 APPLING RD SUITE 102
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City | MEMPHIS
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State | TN
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Zip | 38133-5082
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Country | US
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Telephone | 901-266-7189
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Fax | 901-382-8994
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Provider Business Mailing Address
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Address Line | 2705 APPLING RD SUITE 102
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City | MEMPHIS
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State | TN
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Zip | 38133-5082
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Country | US
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Telephone | 901-266-7189
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Fax | 901-382-8994
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Authorized Official
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Title or Position | OWNER
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Name | DR. DAVID WILLIAM MOSS
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Credential | O.D.
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Telephone | 901-266-7189
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1350
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License Number State | TN
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