Healthcare Provider Details

I. General information

NPI: 1396718318
Provider Name (Legal Business Name): DOVER OPHTHALMOLOGY ASC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 09/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 S BAY RD SUITE 5B
DOVER DE
19901-4615
US

IV. Provider business mailing address

20 BURTON HILLS BLVD. SUITE 500, ATTN: L&C
NASHVILLE TN
37215-6176
US

V. Phone/Fax

Practice location:
  • Phone: 302-678-4688
  • Fax: 302-678-4625
Mailing address:
  • Phone: 615-665-1283
  • Fax: 615-234-1720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberFSSC-005
License Number StateDE

VIII. Authorized Official

Name: MR. PHILLIP CLENDENIN
Title or Position: PRESIDENT
Credential:
Phone: 615-665-1283