Provider Demographics
NPI:1386092682
Name:EAST MEMPHIS EYE ASSOCIATES PLLC
Entity type:Organization
Organization Name:EAST MEMPHIS EYE ASSOCIATES PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:DARWIN
Authorized Official - Last Name:MORMON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:901-757-2020
Mailing Address - Street 1:9031 VALLEY CREST LN
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-7829
Mailing Address - Country:US
Mailing Address - Phone:901-757-2020
Mailing Address - Fax:901-751-2399
Practice Address - Street 1:9031 VALLEY CREST LN
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-7829
Practice Address - Country:US
Practice Address - Phone:901-757-2020
Practice Address - Fax:901-751-2399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-26
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTN2254152W00000X
TNTN3251152W00000X
TNTN3230152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103G701788Medicare UPIN
TN1031415323Medicare UPIN