Eye Care Surgery Center of Olive Branch,LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

EYE CARE SURGERY CENTER OF OLIVE BRANCH,LLC

Practice address

6947 Crumpler Blvd
Suite 105
Olive Branch, MS 38654-1922

Phone

(662) 893-3305

Fax

(662) 893-3306

NPI assigned

Oct 23, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Subba R. Gollamudi, M.D.NPI 1154378735

Title

Medical Director

Phone

(901) 685-2200

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MS

Enrollment records 1

Listed as

Eye Care Surgery Center Olive BranchCCN 25C0001050

Medicare certification status

ActiveFrom the Provider of Services file

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Subba R Gollamudi, M.D.

  • Ophthalmology Physician
  • Memphis, TN
  • NPI 1154378735
  NPD Authorized official
• Andrew W Crothers, M.D.

  • Ophthalmology Physician
  • Memphis, TN
  • NPI 1952500373
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161561600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658707200000",
    "number": "1720161771",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "825 RIDGE LAKE BLVD",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381209411",
            "telephone_number": "901-685-2200",
            "fax_number": "901-255-5631"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6947 CRUMPLER BLVD",
            "address_2": "SUITE 105",
            "city": "OLIVE BRANCH",
            "state": "MS",
            "postal_code": "386541922",
            "telephone_number": "662-893-3305",
            "fax_number": "662-893-3306"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EYE CARE SURGERY CENTER OF OLIVE BRANCH,LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-23",
        "last_updated": "2022-07-25",
        "certification_date": "2022-07-25",
        "status": "A",
        "authorized_official_last_name": "GOLLAMUDI",
        "authorized_official_first_name": "SUBBA",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "901-685-2200",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03058373",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Deborah Lynne Evans, PT
• L Gregory Evans, DDS
• Excellence Concierge Medicine LLC
• Exos Physical Therapy & Sports Medicine, LLC
• Exos Physical Therapy and Sports Medicine, LLC
• Eyedok LLC
• Fab Enterprises LLC
• Fairuza Zan Trust
• Faith of a Mustard Seed Psychiatric Wellness, PLLC
• Blake Jordan Falconello, DPT

• Ambulatory Surgical Clinic/Center in Olive Branch, MS
• Providers in Olive Branch, MS by specialty
• Ambulatory Surgical Clinic/Center in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.