Provider Demographics
NPI:1831316603
Name:COLUMBUS EYE CLINIC & LASER SURGERY CENTER
Entity Type:Organization
Organization Name:COLUMBUS EYE CLINIC & LASER SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:T
Authorized Official - Last Name:BRADLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:662-328-2061
Mailing Address - Street 1:706 HIGHWAY 12 W # F
Mailing Address - Street 2:
Mailing Address - City:STARKVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39759-3573
Mailing Address - Country:US
Mailing Address - Phone:662-328-2061
Mailing Address - Fax:662-328-5000
Practice Address - Street 1:425 HOSPITAL DR
Practice Address - Street 2:SUIT 8
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39705-1901
Practice Address - Country:US
Practice Address - Phone:662-328-2061
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00485369Medicaid
MSC00431Medicare ID - Type Unspecified
MSCE6052Medicare ID - Type Unspecified