Provider Demographics
NPI:1275019044
Name:MVP EYECARE PLLC
Entity Type:Organization
Organization Name:MVP EYECARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MANA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOUSHEHRI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:417-337-3313
Mailing Address - Street 1:2431 N GERMANTOWN PKWY
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38016-4494
Mailing Address - Country:US
Mailing Address - Phone:901-214-0014
Mailing Address - Fax:
Practice Address - Street 1:2431 N GERMANTOWN PKWY
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38016-4494
Practice Address - Country:US
Practice Address - Phone:901-214-0014
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-16
Last Update Date:2018-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3135152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty