Provider Demographics
NPI:1336236710
Name:THE EYE SURGERY AND LASER CENTER
Entity Type:Organization
Organization Name:THE EYE SURGERY AND LASER CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:C
Authorized Official - Last Name:ASHFORD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-985-9120
Mailing Address - Street 1:501 MARSHALL ST
Mailing Address - Street 2:SUITE 604
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39202-1651
Mailing Address - Country:US
Mailing Address - Phone:601-985-9120
Mailing Address - Fax:601-985-9122
Practice Address - Street 1:501 MARSHALL ST
Practice Address - Street 2:SUITE 604
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39202-1651
Practice Address - Country:US
Practice Address - Phone:601-985-9120
Practice Address - Fax:601-985-9122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS07279261QS0132X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS=========OtherBC/BS