Healthcare Provider Details

I. General information

NPI: 1083865232
Provider Name (Legal Business Name): MEMPHIS RETINA PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2008
Last Update Date: 10/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1264 WESLEY DR STE 302
MEMPHIS TN
38116-6445
US

IV. Provider business mailing address

1264 WESLEY DR STE 302
MEMPHIS TN
38116-6445
US

V. Phone/Fax

Practice location:
  • Phone: 901-348-0415
  • Fax: 901-348-0419
Mailing address:
  • Phone: 901-348-0415
  • Fax: 901-522-6521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD0000025588
License Number StateTN

VIII. Authorized Official

Name: DR. SETH L YOSER
Title or Position: OWNER
Credential: MD
Phone: 901-348-0415