Healthcare Provider Details

I. General information

NPI: 1609809326
Provider Name (Legal Business Name): MISSISSIPPI EYE SURGERY CENTER UC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 08/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3432 BIENVILLE BLVD
OCEAN SPRINGS MS
39564
US

IV. Provider business mailing address

3432 BIENVILLE BLVD
OCEAN SPRINGS MS
39564
US

V. Phone/Fax

Practice location:
  • Phone: 228-244-0067
  • Fax: 228-244-0071
Mailing address:
  • Phone: 228-244-0067
  • Fax: 228-244-0071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0900X
TaxonomyAmputee Clinic/Center
License Number
License Number StateMS

VIII. Authorized Official

Name: MS. SANDY ROBERTSON
Title or Position: DIRECTOR
Credential: RN
Phone: 228-244-0067