Provider Demographics
NPI:1750390548
Name:OXFORD EYE SURGERY CENTER,L.P
Entity type:Organization
Organization Name:OXFORD EYE SURGERY CENTER,L.P
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:M
Authorized Official - Last Name:TANN
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:662-234-6621
Mailing Address - Street 1:2604 S LAMAR BLVD
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-5243
Mailing Address - Country:US
Mailing Address - Phone:662-234-6621
Mailing Address - Fax:662-234-8703
Practice Address - Street 1:2604 S LAMAR BLVD
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-5243
Practice Address - Country:US
Practice Address - Phone:662-234-6621
Practice Address - Fax:662-234-8703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS261QS0132X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00770617Medicaid
MS00770617Medicaid