Healthcare Provider Details

I. General information

NPI: 1396828323
Provider Name (Legal Business Name): EYE CARE SURGERY CENTER OF MEMPHIS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 07/25/2022
Certification Date: 07/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5350 POPLAR AVE SUITE 900
MEMPHIS TN
38119-3699
US

IV. Provider business mailing address

825 RIDGE LAKE BLVD
MEMPHIS TN
38120-9411
US

V. Phone/Fax

Practice location:
  • Phone: 901-473-8115
  • Fax: 901-473-8116
Mailing address:
  • Phone: 901-685-2200
  • Fax: 901-255-5631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number0000000167
License Number StateTN

VIII. Authorized Official

Name: DR. SUBBA R. GOLLAMUDI
Title or Position: CHAIRMAN AND MANAGER
Credential: M.D.
Phone: 901-685-2200