Provider Demographics
NPI:1750383295
Name:EYE SURGERY CENTER OF SAINT AUGUSTINE INC
Entity type:Organization
Organization Name:EYE SURGERY CENTER OF SAINT AUGUSTINE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:W
Authorized Official - Last Name:HUND
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:904-829-2344
Mailing Address - Street 1:1400 US HIGHWAY 1 S
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32084-4211
Mailing Address - Country:US
Mailing Address - Phone:904-829-2344
Mailing Address - Fax:
Practice Address - Street 1:1400 US HIGHWAY 1 S
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32084-4211
Practice Address - Country:US
Practice Address - Phone:904-829-2344
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-15
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLF1416261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLLICENSE NUMBEROther1195
FL075723300Medicaid
FLAHCA ID NUMBEROther14960504
FLBLUE CROSS BLUE SHIEOther6G6
FLF1416Medicare PIN