Healthcare Provider Details

I. General information

NPI: 1457331274
Provider Name (Legal Business Name): MONTGOMERY EYE SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 04/22/2022
Certification Date: 04/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2752 ZELDA RD
MONTGOMERY AL
36106-2694
US

IV. Provider business mailing address

2752 ZELDA RD
MONTGOMERY AL
36106-2694
US

V. Phone/Fax

Practice location:
  • Phone: 334-270-9677
  • Fax: 334-213-0622
Mailing address:
  • Phone: 334-270-9677
  • Fax: 334-213-0622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberU5103
License Number StateAL

VIII. Authorized Official

Name: MR. JEFFREY SNODGRASS
Title or Position: PRESIDENT
Credential:
Phone: 615-665-1283