Provider Demographics
NPI:1346912250
Name:SOUTHEAST EYE LASER SURGERY CENTER
Entity Type:Organization
Organization Name:SOUTHEAST EYE LASER SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SURGERY CENTER DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:JORDAN
Authorized Official - Last Name:NEMETZ
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:706-296-7932
Mailing Address - Street 1:3215 SHRINE RD STE 8
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-4300
Mailing Address - Country:US
Mailing Address - Phone:706-296-7932
Mailing Address - Fax:912-574-5824
Practice Address - Street 1:3215 SHRINE RD STE 8
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-4300
Practice Address - Country:US
Practice Address - Phone:706-296-7932
Practice Address - Fax:912-574-5824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-29
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical