MEDICARE: PHYSICIANS EYE SURGERY CENTER PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QS0132X	Ophthalmologic Surgery Clinic/Center
2	261QA1903X	Ambulatory Surgical Clinic/Center

General Provider Information

NPI Number	:	1124608625
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHYSICIANS EYE SURGERY CENTER PLLC

Provider Business Mailing Address
First Line	:	3000 39TH ST
Second Line	:
City	:	PORT ARTHUR
State	:	TX
Zip	:	77642-5517
Country	:	US
Telephone Number	:	409-985-7018
Fax Number	:

Provider Business Practice Location Address
First Line	:	3000 39TH ST
Second Line	:
City	:	PORT ARTHUR
State	:	TX
Zip	:	77642-5517
Country	:	US
Telephone Number	:	409-985-7018
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	RAJ SINGLA
Credential	:	MD
Telephone Number	:	409-985-7018

Provider Enumeration Date	:	04/09/2021
Last Update Date	:	04/09/2021

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