EYE SURGERY CENTER OF AUGUSTA LLC NPI 1104987957

NPI Information

NPI: 1104987957
Provider Name: EYE SURGERY CENTER OF AUGUSTA, LLC
Classification: Clinic/Center - 261QS0132X
Entity Type: Organization

Specialization: Ophthalmologic Surgery

CLIA Number: 11D0957182

Address:
3658 J DEWEY GRAY CIR
AUGUSTA, GA
ZIP 30909
Phone: (706) 651-3937
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EYE SURGERY CENTER OF AUGUSTA, LLC is an ophthalmologic surgery clinic center in Augusta, GA. EYE SURGERY CENTER OF AUGUSTA, LLC NPI is 1104987957. The provider is registered as an organization entity type.

The provider's business location address is:

3658 J DEWEY GRAY CIR
AUGUSTA, GA
ZIP 30909-424
Phone: (706) 651-3937
Fax: (706) 863-3102

The provider's authorized official is Wallace Norman Mcleod .
The authorized official title is President and has the following contact phone number (706) 651-2020.

The CLIA number assigned to this NPI record is 11D0957182 - ambulatory surgery center with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 12/13/2006 and was last updated on 4/20/2008.

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:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QS0132X	Clinic/Center	Ophthalmologic Surgery	121167	GEORGIA	Yes

Other Identifiers

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

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	=========	OTHER		TRICARE
2	ASC020	MEDICAID	SOUTH CAROLINA
3	2189908	OTHER		AETNA HMO
4	7300002	OTHER		AETNA PPO, STANDARD
5	=========	OTHER		BCBSOF GEORGIA
6	324827	OTHER		WELLCARE MANAGED MEDICAID
7	111151ASCA	MEDICARE ID-TYPE UNSPECIFIED
8	00830101A	MEDICAID	GEORGIA
9	10040055	OTHER		AMERIGROUP MGD MEDICAID
10	=========	OTHER		CIGNA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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