Provider Demographics
NPI:1982785846
Name:COLUMBUS EYE CLINIC AND LASER SURGERY CENTER LTD
Entity Type:Organization
Organization Name:COLUMBUS EYE CLINIC AND LASER SURGERY CENTER LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:M
Authorized Official - Last Name:GILLESPIE
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:662-328-2061
Mailing Address - Street 1:425 HOSPITAL DR
Mailing Address - Street 2:SUITE 8
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39705-1938
Mailing Address - Country:US
Mailing Address - Phone:662-328-2061
Mailing Address - Fax:662-328-5000
Practice Address - Street 1:425 HOSPITAL DR
Practice Address - Street 2:SUITE 8
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39705-1938
Practice Address - Country:US
Practice Address - Phone:662-328-2061
Practice Address - Fax:662-328-5000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00485369Medicaid
MSCE6052Medicare PIN
MSC00431Medicare PIN