Provider Demographics
NPI:1821336371
Name:EYECARE SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:EYECARE SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KIRK
Authorized Official - Middle Name:R
Authorized Official - Last Name:JEFFREYS
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:601-366-1085
Mailing Address - Street 1:1501 LAKELAND DR STE 101
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4839
Mailing Address - Country:US
Mailing Address - Phone:601-366-1085
Mailing Address - Fax:601-366-5186
Practice Address - Street 1:1501 LAKELAND DR STE 101
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4839
Practice Address - Country:US
Practice Address - Phone:601-366-1085
Practice Address - Fax:601-366-5186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-17
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS14957261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00120588Medicaid
MS00120588Medicaid