Provider Demographics
NPI:1467060327
Name:SUMMIT EYE CARE SURGERY CENTER, PLLC
Entity Type:Organization
Organization Name:SUMMIT EYE CARE SURGERY CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:VICKAS
Authorized Official - Middle Name:
Authorized Official - Last Name:KHEMSARA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-765-0910
Mailing Address - Street 1:3073 TRENWEST DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-3207
Mailing Address - Country:US
Mailing Address - Phone:336-765-0960
Mailing Address - Fax:336-765-7453
Practice Address - Street 1:3073 TRENWEST DR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3207
Practice Address - Country:US
Practice Address - Phone:336-765-0960
Practice Address - Fax:336-765-7453
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-16
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery