Provider Demographics
NPI:1972687176
Name:FOOSHEE OPTICAL DISPENSARY
Entity Type:Organization
Organization Name:FOOSHEE OPTICAL DISPENSARY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:OLIS
Authorized Official - Middle Name:J
Authorized Official - Last Name:FOOSHEE
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:901-377-0232
Mailing Address - Street 1:5127 YALE RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38134-8218
Mailing Address - Country:US
Mailing Address - Phone:901-377-0232
Mailing Address - Fax:
Practice Address - Street 1:5127 YALE RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38134-8218
Practice Address - Country:US
Practice Address - Phone:901-377-0232
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDPO241332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0137430001Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER