Provider Demographics
NPI:1730309675
Name:EYECARE CENTER OF MEMPHIS, INC.
Entity Type:Organization
Organization Name:EYECARE CENTER OF MEMPHIS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:MOSS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:901-266-7189
Mailing Address - Street 1:2705 APPLING RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38133-5082
Mailing Address - Country:US
Mailing Address - Phone:901-266-7189
Mailing Address - Fax:901-382-8994
Practice Address - Street 1:2705 APPLING RD
Practice Address - Street 2:SUITE 102
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38133-5082
Practice Address - Country:US
Practice Address - Phone:901-266-7189
Practice Address - Fax:901-382-8994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1350152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1350OtherMOSS LICENSE
TN3596890Medicaid
TN1142OtherRAMOS LICENSE
TN1376587436OtherMOSS NPI
TN1861500175OtherRAMOS NPI
TN4381781Medicaid
TN1350OtherMOSS LICENSE
TN3596890Medicaid
TN4381781Medicaid
TN4381781Medicare ID - Type UnspecifiedMOSS