Provider Demographics
NPI:1841368867
Name:DUBLIN EYE SURGERY CENTER LLC
Entity type:Organization
Organization Name:DUBLIN EYE SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:R
Authorized Official - Last Name:OZMENT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:478-274-9600
Mailing Address - Street 1:2400 BELLEVUE RD
Mailing Address - Street 2:17 ERIN OFFICE PARK
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31021-2885
Mailing Address - Country:US
Mailing Address - Phone:478-274-9600
Mailing Address - Fax:478-274-0936
Practice Address - Street 1:2400 BELLEVUE RD
Practice Address - Street 2:17 ERIN OFFICE PARK
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-2885
Practice Address - Country:US
Practice Address - Phone:478-274-9600
Practice Address - Fax:478-274-0936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA111266ASCAMedicare ID - Type Unspecified