Eye Care Surgery Center Of Olive Branch,llc
Clinic/Center, Ambulatory Surgical in Olive Branch, MS. Organization (NPI-2).
NPI number1720161771
StatusActive
Last updated in NPPESJul 25, 2022
Details
- NPI
- 1720161771
- Entity type
- Organization (NPI-2)
- Legal business name
- Eye Care Surgery Center Of Olive Branch,llc
- Organization subpart
- No
- Enumeration date
- Oct 23, 2006
- Certification date
- Jul 25, 2022
- Last updated
- Jul 25, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QA1903X | Clinic/Center, Ambulatory Surgical | – | – | Yes |
Practice location
6947 Crumpler BlvdSuite 105
Olive Branch, MS 38654-1922
Phone 662-893-3305 · Fax 662-893-3306
Mailing address
825 Ridge Lake BlvdMemphis, TN 38120-9411
Phone 901-685-2200 · Fax 901-255-5631
Authorized official
Subba R. Gollamudi
Medical Director
9016852200
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