Organization
LAKE SHORE RETINA, S.C. CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SRILAKSHMI MAGULURI MD (PRESIDENT)
(773) 677-2962
Entity
Organization
Contact information
Practice address
1208 GAY ST, DANDRIDGE, TN 37725-4720
(865) 484-9948
Mailing address
PO BOX 1751, DANDRIDGE, TN 37725-1751
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
—
—
Other
Enumeration date
08/25/2009
Last updated
01/10/2024
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