Provider Demographics
NPI:1750601803
Name:KERNERSVILLE EYE SURGEONS, PC
Entity type:Organization
Organization Name:KERNERSVILLE EYE SURGEONS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:A
Authorized Official - Last Name:HAGEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-992-9637
Mailing Address - Street 1:210 N MAIN ST STE 144
Mailing Address - Street 2:
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27284-4003
Mailing Address - Country:US
Mailing Address - Phone:336-992-9637
Mailing Address - Fax:336-992-9638
Practice Address - Street 1:210 N MAIN ST STE 144
Practice Address - Street 2:
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284-4003
Practice Address - Country:US
Practice Address - Phone:336-992-9637
Practice Address - Fax:336-992-9638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-10
Last Update Date:2024-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty