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General NPI Number Information
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NPI Number | 1245480482
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Entity Type | Organization
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Legal Business Name | COLEMAN CATARACT AND EYE LASER SURGERY CENTER, INC.
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Dates
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Enumeration Date | 09/24/2008
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Last Update Date | 09/24/2008
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Provider Practice Location Address
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Address Line | 2005 HWY 82 W
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City | GREENWOOD
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State | MS
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Zip | 38930
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Country | US
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Telephone | 662-455-4523
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Fax | 662-455-3790
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Provider Business Mailing Address
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Address Line | 2005 HWY 82 W
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City | GREENWOOD
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State | MS
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Zip | 38930
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Country | US
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Telephone | 662-455-4523
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Fax | 662-455-3790
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Authorized Official
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Title or Position | RN/ADMINISTRATOR
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Name | AMY BUSH
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Credential |
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Telephone | 662-455-4523
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS0132X
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Taxonomy Name | Ophthalmologic Surgery Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | R792327
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License Number State | MS
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