Provider Demographics
NPI:1942366737
Name:KOCH EYE SURGICENTER, INC.
Entity Type:Organization
Organization Name:KOCH EYE SURGICENTER, INC.
Other - Org Name:ST. JAMES SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:A
Authorized Official - Last Name:KOCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-738-4800
Mailing Address - Street 1:566 TOLL GATE RD
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-2716
Mailing Address - Country:US
Mailing Address - Phone:401-738-4800
Mailing Address - Fax:401-738-8153
Practice Address - Street 1:444 QUAKER LN
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-0103
Practice Address - Country:US
Practice Address - Phone:401-384-6537
Practice Address - Fax:401-384-6541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIFAS101016261QS0132X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery