Organization
MIDSOUTH VISION CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MELISSA ANN BLAICHER OPTICIAN (MANAGER/OPTICIAN)
(901) 373-4207
Entity
Organization
Contact information
Practice address
3314 POPLAR AVE STE#1, MEMPHIS, TN 38111
(901) 324-3189
(901) 324-2851
Mailing address
3314 POPLAR AVE SUITE #1, MEMPHIS, TN 38111
(901) 324-3189
(901) 324-2851
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
TN611
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100197
—
TN
Enumeration date
10/17/2012
Last updated
10/17/2012
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