Healthcare Provider Details

I. General information

NPI: 1821336371
Provider Name (Legal Business Name): EYECARE SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2013
Last Update Date: 01/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 LAKELAND DR STE 101
JACKSON MS
39216-4839
US

IV. Provider business mailing address

1501 LAKELAND DR STE 101
JACKSON MS
39216-4839
US

V. Phone/Fax

Practice location:
  • Phone: 601-366-1085
  • Fax: 601-366-5186
Mailing address:
  • Phone: 601-366-1085
  • Fax: 601-366-5186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number14957
License Number StateMS

VIII. Authorized Official

Name: DR. KIRK R JEFFREYS III
Title or Position: OWNER
Credential: M.D.
Phone: 601-366-1085