Lake Shore Retina, S.c. Corp

NPI #1255564258 in Dandridge, Tennessee

Provider Information

NPI Number: 1255564258
Entity Type: Organization
Organization Name: Lake Shore Retina, S.c. Corp
Primary Specialty: Ophthalmology
Enumeration Date: Aug 25, 2009
Last Updated: Jan 10, 2024

Practice Location

Address: 1208 GAY ST
City: Dandridge
State: Tennessee
ZIP Code: 37725-4720
Phone: (865) 484-9948

Authorized Official

Name: SRILAKSHMI MAGULURI, MD
Title: PRESIDENT
Phone: (773) 677-2962

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Ophthalmology	207W00000X	Primary

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