Provider Demographics
NPI:1114929957
Name:OPHTHALMIC OUTPATIENT SURGERY CENTER PARTNERS, LLC
Entity Type:Organization
Organization Name:OPHTHALMIC OUTPATIENT SURGERY CENTER PARTNERS, LLC
Other - Org Name:OUTPATIENT SURGERY CENTER FOR SIGHT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:H
Authorized Official - Last Name:WILLIAMSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:225-925-2031
Mailing Address - Street 1:550 CONNELL PARK LN
Mailing Address - Street 2:SUITE B
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-6539
Mailing Address - Country:US
Mailing Address - Phone:225-925-2031
Mailing Address - Fax:225-924-2809
Practice Address - Street 1:550 CONNELLS PARK LN
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-6539
Practice Address - Country:US
Practice Address - Phone:225-923-8250
Practice Address - Fax:225-925-0225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-11
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA129261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4435448OtherAETNA PIN
LA1900220254ZOtherBC PIN
LA1911488Medicaid
LA4435448OtherAETNA PIN