Provider Demographics
NPI:1396781647
Name:MEMPHIS EYE AND CATARACT ASSOCIATES PLC
Entity type:Organization
Organization Name:MEMPHIS EYE AND CATARACT ASSOCIATES PLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRE
Authorized Official - Middle Name:M
Authorized Official - Last Name:FREEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-767-4407
Mailing Address - Street 1:6485 POPLAR AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-4864
Mailing Address - Country:US
Mailing Address - Phone:901-767-4407
Mailing Address - Fax:901-767-3048
Practice Address - Street 1:6485 POPLAR AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-4864
Practice Address - Country:US
Practice Address - Phone:901-767-4407
Practice Address - Fax:901-767-3048
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEMPHIS EYE AND CATARACT ASSOCIATES PLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-22
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN332B00000X
332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3942639Medicaid
TN3130339OtherBCBSTN
TN3942639Medicaid