Provider Demographics
NPI:1689643322
Name:EYE SURGERY CENTER OF ALBANY, LLC
Entity Type:Organization
Organization Name:EYE SURGERY CENTER OF ALBANY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:
Authorized Official - First Name:MARNIX
Authorized Official - Middle Name:E
Authorized Official - Last Name:HEERSINK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-793-2211
Mailing Address - Street 1:2308 PALMYRA ROAD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31701-1324
Mailing Address - Country:US
Mailing Address - Phone:229-888-2395
Mailing Address - Fax:
Practice Address - Street 1:2308 PALMYRA ROAD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-1324
Practice Address - Country:US
Practice Address - Phone:229-888-2395
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EYE PARTNERS PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-03-15
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA047-325261QS0132X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA047-325OtherFACILITY PERMIT NUMBER
P00286475Medicare PIN
GA111275ASCAMedicare ID - Type Unspecified