Provider Demographics
NPI:1720264468
Name:PASSONS EYE CENTER, P.L.L.C.
Entity Type:Organization
Organization Name:PASSONS EYE CENTER, P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:A
Authorized Official - Last Name:PASSONS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-683-1112
Mailing Address - Street 1:909 RIDGEWAY LOOP RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-4016
Mailing Address - Country:US
Mailing Address - Phone:901-683-1112
Mailing Address - Fax:901-683-1174
Practice Address - Street 1:909 RIDGEWAY LOOP RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-4016
Practice Address - Country:US
Practice Address - Phone:901-683-1112
Practice Address - Fax:901-683-1174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-11
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTNOD641T152W00000X
TNMD12831207W00000X
TNMD36450207W00000X
TNMD43481207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4176557OtherBLUE CROSS BLUE SHIELD OF TENNESSEE
TN30235062Medicaid
TN30235062Medicare PIN