Provider Demographics
NPI:1881743375
Name:WEST TENNESSEE EYE CARE, PC
Entity type:Organization
Organization Name:WEST TENNESSEE EYE CARE, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROLANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:TOYOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-683-7255
Mailing Address - Street 1:PO BOX 1798
Mailing Address - Street 2:DEPT 07-004
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:72403-0717
Mailing Address - Country:US
Mailing Address - Phone:901-683-7255
Mailing Address - Fax:901-683-3523
Practice Address - Street 1:6465 N QUAIL HOLLOW RD STE 100
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-1448
Practice Address - Country:US
Practice Address - Phone:901-683-7255
Practice Address - Fax:901-683-3523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOD2259152W00000X
TNMD30047207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3945388Medicare PIN
3372454Medicare UPIN
TN3372454Medicare PIN