Provider Demographics
NPI:1104941129
Name:KENDRICK, MEADE H III (OD)
Entity type:Individual
Prefix:DR
First Name:MEADE
Middle Name:H
Last Name:KENDRICK
Suffix:III
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:MEADE
Other - Middle Name:H
Other - Last Name:KENDRICK
Other - Suffix:III
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:6150 POPLAR AVE STE 115
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-4744
Mailing Address - Country:US
Mailing Address - Phone:901-682-3937
Mailing Address - Fax:
Practice Address - Street 1:6150 POPLAR AVE STE 115
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-4744
Practice Address - Country:US
Practice Address - Phone:901-682-3937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTOD1158152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNU61316Medicare UPIN
TN3944866Medicare ID - Type Unspecified