Healthcare Provider Details

I. General information

NPI: 1437202967
Provider Name (Legal Business Name): REGIONAL EYE SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 05/16/2023
Certification Date: 05/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1455 MONTREAL ST SE
HUTCHINSON MN
55350
US

IV. Provider business mailing address

1455 MONTREAL ST SE PO BOX 699
HUTCHINSON MN
55350-0699
US

V. Phone/Fax

Practice location:
  • Phone: 320-587-6308
  • Fax: 320-587-2974
Mailing address:
  • Phone: 320-587-6308
  • Fax: 320-587-2974

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: CLIFTON BAZHAW
Title or Position: VP REVENUE CYCLE
Credential:
Phone: 469-270-6658