Provider Demographics
NPI:1124511266
Name:CASSIDY, THERESA KARYN (OD)
Entity type:Individual
Prefix:DR
First Name:THERESA
Middle Name:KARYN
Last Name:CASSIDY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MS
Other - First Name:THERESA
Other - Middle Name:KARYN
Other - Last Name:REED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6485 POPLAR AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-4838
Mailing Address - Country:US
Mailing Address - Phone:901-767-3937
Mailing Address - Fax:901-767-1747
Practice Address - Street 1:1689 NONCONNAH BLVD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38132-2105
Practice Address - Country:US
Practice Address - Phone:901-523-8990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-13
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3470152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist