Organization
OPTICAL OUTLET, INC
Active
Other names
Optical Outlet
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KENNETH A WEINBERG O.D. (PRESIDENT)
(901) 683-3232
Entity
Organization
Contact information
Practice address
826 MOUNT MORIAH RD, MEMPHIS, TN 38117-5705
(901) 683-3232
(901) 683-4463
Mailing address
826 MOUNT MORIAH RD, MEMPHIS, TN 38117-5705
(901) 683-3232
(901) 683-4463
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
749
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0785940002
PALMETTO DME
TN
Enumeration date
07/31/2008
Last updated
07/31/2008
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