Healthcare Provider Details

I. General information

NPI: 1356497747
Provider Name (Legal Business Name): MACON EYE SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 02/17/2026
Certification Date: 02/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

864 1ST ST
MACON GA
31201-6875
US

IV. Provider business mailing address

PO BOX 6908
WARNER ROBINS GA
31095-6908
US

V. Phone/Fax

Practice location:
  • Phone: 478-259-2481
  • Fax: 478-812-4028
Mailing address:
  • Phone: 478-551-4642
  • Fax: 478-929-6266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: ALISHA STONE
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 478-551-4642