Provider Demographics
NPI:1871548107
Name:OPTOMETRY GROUP
Entity type:Organization
Organization Name:OPTOMETRY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:N
Authorized Official - Last Name:HINES
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:901-458-2020
Mailing Address - Street 1:3445 POPLAR AVE
Mailing Address - Street 2:SUITE 7
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38111-4667
Mailing Address - Country:US
Mailing Address - Phone:901-458-2020
Mailing Address - Fax:901-458-2099
Practice Address - Street 1:3445 POPLAR AVE
Practice Address - Street 2:SUITE 7
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38111-4667
Practice Address - Country:US
Practice Address - Phone:901-458-2020
Practice Address - Fax:901-458-2099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0784010001OtherDMERC REGION C PALMETTO GBA
TN0784010001Medicare NSC
TN0784010001OtherDMERC REGION C PALMETTO GBA