Provider Demographics
NPI:1558423962
Name:WEST TENNESSEE EYE, PLC
Entity Type:Organization
Organization Name:WEST TENNESSEE EYE, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING & INSURANCE COORDINAT
Authorized Official - Prefix:MS
Authorized Official - First Name:KENDALL
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:DUCKETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-357-0371
Mailing Address - Street 1:2070 WHITNEY AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38127-9014
Mailing Address - Country:US
Mailing Address - Phone:901-357-0371
Mailing Address - Fax:901-358-7574
Practice Address - Street 1:2070 WHITNEY AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38127-9014
Practice Address - Country:US
Practice Address - Phone:901-357-0371
Practice Address - Fax:901-358-7574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1797152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0261030001Medicare NSC
TN3941291Medicare ID - Type Unspecified