Healthcare Provider Details

I. General information

NPI: 1124283510
Provider Name (Legal Business Name): WILLS EYE SURGERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2008
Last Update Date: 07/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 FOULK RD
WILMINGTON DE
19803-3155
US

IV. Provider business mailing address

900 FOULK RD
WILMINGTON DE
19803-3155
US

V. Phone/Fax

Practice location:
  • Phone: 302-777-4800
  • Fax:
Mailing address:
  • Phone: 302-777-4800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberFSSC-007
License Number StateDE

VIII. Authorized Official

Name: KRISTIN D BREWER
Title or Position: MEDICAL BILLER
Credential:
Phone: 302-377-3101