Provider Demographics
NPI:1750397576
Name:AMBATI, BALAMURALI KRISHNA (MD)
Entity type:Individual
Prefix:DR
First Name:BALAMURALI
Middle Name:KRISHNA
Last Name:AMBATI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 S GARDEN WAY STE 250
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-8175
Mailing Address - Country:US
Mailing Address - Phone:541-343-5000
Mailing Address - Fax:
Practice Address - Street 1:360 S GARDEN WAY STE 250
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-8175
Practice Address - Country:US
Practice Address - Phone:541-343-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6771485-1205207W00000X
ORMD178830207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology