Provider Demographics
NPI:1477721256
Name:ST FRANCIS OPTICAL DISPENSARY
Entity Type:Organization
Organization Name:ST FRANCIS OPTICAL DISPENSARY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:PAGANO
Authorized Official - Suffix:SR
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:901-761-2390
Mailing Address - Street 1:6005 PARK AVE
Mailing Address - Street 2:ST FRANCIS OPTICAL DISPENSARY
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-5202
Mailing Address - Country:US
Mailing Address - Phone:901-761-2390
Mailing Address - Fax:
Practice Address - Street 1:6005 PARK AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-5202
Practice Address - Country:US
Practice Address - Phone:901-761-2390
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-14
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN294156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0554670001Medicare PIN