Provider Demographics
NPI:1346426202
Name:MEMPHIS FAMILY VISION PRACTICE
Entity Type:Organization
Organization Name:MEMPHIS FAMILY VISION PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:
Authorized Official - Last Name:EISENSTATT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:901-767-7080
Mailing Address - Street 1:857 MOUNT MORIAH RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38117-5704
Mailing Address - Country:US
Mailing Address - Phone:901-767-7080
Mailing Address - Fax:901-767-2020
Practice Address - Street 1:857 MOUNT MORIAH RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38117-5704
Practice Address - Country:US
Practice Address - Phone:901-767-7080
Practice Address - Fax:901-767-2020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-10
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0181140001Medicare NSC