Provider Demographics
NPI:1568930170
Name:901 OPTICAL LLC
Entity Type:Organization
Organization Name:901 OPTICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:BILLS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:901-737-1333
Mailing Address - Street 1:1795 N GERMANTOWN PKWY
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38016-5092
Mailing Address - Country:US
Mailing Address - Phone:901-737-1333
Mailing Address - Fax:901-473-1723
Practice Address - Street 1:1795 N GERMANTOWN PKWY
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38016-5092
Practice Address - Country:US
Practice Address - Phone:901-737-1333
Practice Address - Fax:901-473-1723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-13
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center