Provider Demographics
NPI:1376062729
Name:SILDIRYAN, LORIG (OD)
Entity Type:Individual
Prefix:
First Name:LORIG
Middle Name:
Last Name:SILDIRYAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:930 MADISON AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38103-7400
Mailing Address - Country:US
Mailing Address - Phone:901-287-7337
Mailing Address - Fax:
Practice Address - Street 1:930 MADISON AVE STE 400
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38103-7400
Practice Address - Country:US
Practice Address - Phone:901-287-7337
Practice Address - Fax:901-448-1813
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-18
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG003347152W00000X
TN3487152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ060865Medicaid