Healthcare Provider Details

I. General information

NPI: 1003413527
Provider Name (Legal Business Name): CENTER FOR OPHTHALMIC SURGERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2020
Last Update Date: 11/11/2022
Certification Date: 11/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3745 CORPORATE WOODS DR
VESTAVIA AL
35242-2208
US

IV. Provider business mailing address

3745 CORPORATE WOODS DR
VESTAVIA AL
35242-2208
US

V. Phone/Fax

Practice location:
  • Phone: 205-933-1077
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOHN PARKER
Title or Position: OWNER
Credential: MD
Phone: 205-933-1077