Provider Demographics
NPI:1144535584
Name:EYE SPECTRUM
Entity type:Organization
Organization Name:EYE SPECTRUM
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MEADE
Authorized Official - Middle Name:HAMMOND
Authorized Official - Last Name:KENDRICK
Authorized Official - Suffix:III
Authorized Official - Credentials:OD
Authorized Official - Phone:901-682-3937
Mailing Address - Street 1:6150 POPLAR AVE
Mailing Address - Street 2:SUITE 115
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-4784
Mailing Address - Country:US
Mailing Address - Phone:901-682-3937
Mailing Address - Fax:901-683-6172
Practice Address - Street 1:6150 POPLAR AVE
Practice Address - Street 2:SUITE 115
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-4784
Practice Address - Country:US
Practice Address - Phone:901-682-3937
Practice Address - Fax:901-683-6172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-10
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTOD 1158332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier