Organization
MOBILE DIAGNOSTIC EYECARE
Active
Other names
Diagnostic Eyecare
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DONNA MARIE HASTINGS DPO (LICENSED OPTICIAN/CEO)
(901) 766-6742
Entity
Organization
Contact information
Practice address
2750 MOUNT MORIAH PKWY, MEMPHIS, TN 38115-2063
(901) 766-6742
(901) 766-6743
Mailing address
2750 MOUNT MORIAH PKWY, MEMPHIS, TN 38115-2063
(901) 766-6742
(901) 766-6743
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
962
TN
302F00000X
Exclusive Provider Organization
962
TN
305R00000X
Preferred Provider Organization
962
TN
332H00000X
Eyewear Supplier
Primary
962
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4058078
BCBS
TN
Enumeration date
07/31/2007
Last updated
08/08/2014
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