Provider Demographics
NPI:1740473404
Name:VISIONARY EYE CARE, PC
Entity type:Organization
Organization Name:VISIONARY EYE CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FARAMARZ
Authorized Official - Middle Name:FRED
Authorized Official - Last Name:HIDAJI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-754-3937
Mailing Address - Street 1:6252 POPLAR AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-4713
Mailing Address - Country:US
Mailing Address - Phone:901-754-3937
Mailing Address - Fax:901-680-7771
Practice Address - Street 1:6252 POPLAR AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-4713
Practice Address - Country:US
Practice Address - Phone:901-754-3937
Practice Address - Fax:901-680-7771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-24
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000034186174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty