Provider Demographics
NPI:1528206141
Name:HATTIESBURG EYE CLINIC CATARACT & LASIK SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:HATTIESBURG EYE CLINIC CATARACT & LASIK SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STONEY
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-268-5910
Mailing Address - Street 1:103 MILLSAPS DR
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-1348
Mailing Address - Country:US
Mailing Address - Phone:601-268-9959
Mailing Address - Fax:601-268-9947
Practice Address - Street 1:103 MILLSAPS DR
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-1348
Practice Address - Country:US
Practice Address - Phone:601-268-9959
Practice Address - Fax:601-268-9947
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-04
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03922537Medicaid
MS03922537Medicaid