MEDICARE: LAUREN C DITTA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	49752	TN

General Provider Information

NPI Number	:	1417190877
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN C DITTA M.D.

Provider Business Mailing Address
First Line	:	850 POPLAR AVE BLDG 2
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38105-4607
Country	:	US
Telephone Number	:	901-287-5565
Fax Number	:

Provider Business Practice Location Address
First Line	:	930 MADISON AVE STE 400
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38103-7400
Country	:	US
Telephone Number	:	901-287-7337
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/15/2009
Last Update Date	:	02/05/2019

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