Provider Demographics
NPI:1235255605
Name:EAGLE EYE SURGERY AND LASER CENTER LLC
Entity Type:Organization
Organization Name:EAGLE EYE SURGERY AND LASER CENTER LLC
Other - Org Name:EAGLE EYE SURGERY & LASER CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:SNODGRASS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-665-1283
Mailing Address - Street 1:1A BURTON HILLS BLVD
Mailing Address - Street 2:ATTN: L&C
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37215-6103
Mailing Address - Country:US
Mailing Address - Phone:615-665-1283
Mailing Address - Fax:615-234-1720
Practice Address - Street 1:3090 E GENTRY WAY STE 100
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-3548
Practice Address - Country:US
Practice Address - Phone:208-288-1600
Practice Address - Fax:208-288-4299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010029603OtherREGENCE BLUE SHIELD
ID805834800Medicaid
ID04093OtherBLUE CROSS
OR150695Medicaid
ID490004716OtherRAILROAD MEDICARE
ID490004716OtherRAILROAD MEDICARE
ID805834800Medicaid