Healthcare Provider Details

I. General information

NPI: 1033571088
Provider Name (Legal Business Name): PRISCILLA APRIL LAO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2016
Last Update Date: 03/13/2025
Certification Date: 03/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 MADISON AVE STE 200
MEMPHIS TN
38103-3452
US

IV. Provider business mailing address

1068 CRESTHAVEN RD STE 300
MEMPHIS TN
38119-0809
US

V. Phone/Fax

Practice location:
  • Phone: 901-448-6650
  • Fax: 901-302-2486
Mailing address:
  • Phone: 901-866-8864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number65598
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207WX0109X
TaxonomyNeuro-ophthalmology Physician
License NumberMD470133
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207WX0109X
TaxonomyNeuro-ophthalmology Physician
License Number65598
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: