Organization
EYE CARE SURGERY CENTER OF OLIVE BRANCH,LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SUBBA R. GOLLAMUDI M.D. (MEDICAL DIRECTOR)
(901) 685-2200
Entity
Organization
Contact information
Practice address
6947 CRUMPLER BLVD, SUITE 105, OLIVE BRANCH, MS 38654-1922
(662) 893-3305
(662) 893-3306
Mailing address
825 RIDGE LAKE BLVD, MEMPHIS, TN 38120-9411
(901) 685-2200
(901) 255-5631
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03058373
—
MS
Enumeration date
10/23/2006
Last updated
07/25/2022
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