Provider Demographics
NPI:1043517501
Name:VISIONS FAMILY EYE CARE & OPTICAL BOUTIQUE
Entity Type:Organization
Organization Name:VISIONS FAMILY EYE CARE & OPTICAL BOUTIQUE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR/OWENER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEAH
Authorized Official - Middle Name:M
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:901-729-7780
Mailing Address - Street 1:3624 AUSTIN PEAY HWY
Mailing Address - Street 2:SUITE 6
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38128-3776
Mailing Address - Country:US
Mailing Address - Phone:901-729-7780
Mailing Address - Fax:901-729-7785
Practice Address - Street 1:3624 AUSTIN PEAY HWY
Practice Address - Street 2:SUITE 6
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38128-3776
Practice Address - Country:US
Practice Address - Phone:901-729-7780
Practice Address - Fax:901-729-7785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-18
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2884152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty