Provider Demographics
NPI:1396991832
Name:MEMPHIS RETINA, PLLC
Entity type:Organization
Organization Name:MEMPHIS RETINA, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SETH
Authorized Official - Middle Name:L
Authorized Official - Last Name:YOSER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-348-0415
Mailing Address - Street 1:PO BOX 1000 DEPT 919
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38148-0919
Mailing Address - Country:US
Mailing Address - Phone:901-377-8727
Mailing Address - Fax:
Practice Address - Street 1:1264 WESLEY DR
Practice Address - Street 2:SUITE 302
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38116-6400
Practice Address - Country:US
Practice Address - Phone:901-348-0415
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-15
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN25588207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3084098Medicaid
F10028Medicare UPIN
TN30840912Medicare PIN