DESOTO EYE SURGERY CENTER LLC NPI 1073754602

NPI Information

DESOTO EYE SURGERY CENTER LLC is an ambulatory surgical clinic center in Southaven, MS. DESOTO EYE SURGERY CENTER LLC NPI is 1073754602. The provider is registered as an organization entity type.

The provider's business location address is:

726 GOODMAN RD E
SUITE B
SOUTHAVEN, MS
ZIP 38671-530
Phone: (662) 349-1959
Fax: (662) 349-0424

The provider's authorized official is Alan R. Schaeffer .
The authorized official title is Managing Member and has the following contact phone number (662) 349-1959.

The CLIA number assigned to this NPI record is 25D1098836 - ambulatory surgery center with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 3/11/2009 and was last updated on 4/5/2012.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

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