Provider Demographics
NPI:1154449643
Name:AUGUSTA EYE SURGERY, LLC
Entity Type:Organization
Organization Name:AUGUSTA EYE SURGERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:COE
Authorized Official - Phone:706-922-6000
Mailing Address - Street 1:905 STEVENS CREEK RD
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30907-3201
Mailing Address - Country:US
Mailing Address - Phone:706-922-6000
Mailing Address - Fax:706-722-7994
Practice Address - Street 1:905 STEVENS CREEK RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30907-3201
Practice Address - Country:US
Practice Address - Phone:706-922-6000
Practice Address - Fax:706-722-7994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical