EYE LASER AND SURGERY CENTER LLC NPI 1578881009

NPI Information

NPI: 1578881009
Provider Name: EYE LASER AND SURGERY CENTER LLC
Classification: Clinic/Center - 261QA1903X
Entity Type: Organization

Specialization: Ambulatory Surgical

CLIA Number: 36D2015241

Address:
4235 INDIAN RIPPLE RD
STE 110
BEAVERCREEK, OH
ZIP 45440
Phone: (937) 427-7800
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EYE LASER AND SURGERY CENTER LLC is an ambulatory surgical clinic center in Beavercreek, OH. EYE LASER AND SURGERY CENTER LLC NPI is 1578881009. The provider is registered as an organization entity type.

The provider's business location address is:

4235 INDIAN RIPPLE RD
STE 110
BEAVERCREEK, OH
ZIP 45440-265
Phone: (937) 427-7800
Fax: (937) 427-7803

The provider's authorized official is Brian R Stahl .
The authorized official title is Managing Partner/president and has the following contact phone number (937) 427-2020.

The CLIA number assigned to this NPI record is 36D2015241 - ambulatory surgery center with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 5/7/2010 and was last updated on 1/10/2013.

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	0991AS	OHIO	No
2	261QA1903X	Clinic/Center	Ambulatory Surgical	0991AS	OHIO	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
1	P01107323	MEDICARE PIN	OHIO
2	0055714	MEDICAID	OHIO
3	H017510	MEDICARE PIN	OHIO

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

NPI Synchronization or Removal

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