Healthcare Provider Details

I. General information

NPI: 1740413400
Provider Name (Legal Business Name): ATLANTIC SURGERY & LASER CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2009
Last Update Date: 12/16/2024
Certification Date: 12/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8040 N WICKHAM RD STE 101
MELBOURNE FL
32940-8298
US

IV. Provider business mailing address

8040 N WICKHAM RD STE 101
MELBOURNE FL
32940-8298
US

V. Phone/Fax

Practice location:
  • Phone: 321-757-7276
  • Fax: 321-757-7211
Mailing address:
  • Phone: 321-757-7276
  • Fax: 321-757-7211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. JASON DARLINGTON
Title or Position: PRESIDENT/MEDICAL DIRECTOR
Credential: M.D,
Phone: 321-757-7276