Provider Demographics
NPI:1457331274
Name:MONTGOMERY EYE SURGERY CENTER LLC
Entity Type:Organization
Organization Name:MONTGOMERY EYE SURGERY CENTER LLC
Other - Org Name:THE MONTGOMERY EYE SURGERY 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 1:2752 ZELDA RD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106-2694
Mailing Address - Country:US
Mailing Address - Phone:334-270-9677
Mailing Address - Fax:334-213-0622
Practice Address - Street 1:2752 ZELDA RD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-2694
Practice Address - Country:US
Practice Address - Phone:334-270-9677
Practice Address - Fax:334-213-0622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-18
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALU5103261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALASC0051CMedicaid
AL102I433009OtherCRNA - BLATZ
AL01-C0001026Medicare Oscar/Certification
ALASC0051CMedicaid
AL29207Medicare PIN