Provider Demographics
NPI:1710920475
Name:ULTRA EYECARE
Entity Type:Organization
Organization Name:ULTRA EYECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTHALMOLOGY
Authorized Official - Prefix:MR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHAEFFER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-458-4475
Mailing Address - Street 1:3460 PLAZA AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38111
Mailing Address - Country:US
Mailing Address - Phone:901-458-4475
Mailing Address - Fax:901-458-9854
Practice Address - Street 1:3460 PLAZA AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38111-4614
Practice Address - Country:US
Practice Address - Phone:901-458-4475
Practice Address - Fax:901-458-9854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS14992152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSA13768Medicare UPIN