Provider Demographics
NPI:1851532832
Name:LS OF MEMPHIS, PC
Entity Type:Organization
Organization Name:LS OF MEMPHIS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:V
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-685-5520
Mailing Address - Street 1:1714 W MASSEY RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-4205
Mailing Address - Country:US
Mailing Address - Phone:901-685-5520
Mailing Address - Fax:901-685-0782
Practice Address - Street 1:1714 W MASSEY RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-4205
Practice Address - Country:US
Practice Address - Phone:901-685-5520
Practice Address - Fax:901-685-0782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-20
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOD0000002462152W00000X
TNMD0000004321207R00000X
TNMD0000014235207R00000X
TNMD0000025750207R00000X
TNMD0000004189207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty