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General NPI Number Information
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NPI Number | 1346912250
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Entity Type | Organization
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Legal Business Name | SOUTHEAST EYE LASER SURGERY CENTER
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Dates
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Enumeration Date | 09/29/2021
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Last Update Date | 09/29/2021
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Provider Practice Location Address
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Address Line | 3215 SHRINE RD STE 8
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City | BRUNSWICK
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State | GA
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Zip | 31520-4300
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Country | US
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Telephone | 706-296-7932
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Fax | 912-574-5824
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Provider Business Mailing Address
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Address Line | 3215 SHRINE RD STE 8
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City | BRUNSWICK
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State | GA
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Zip | 31520-4300
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Country | US
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Telephone | 706-296-7932
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Fax | 912-574-5824
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Authorized Official
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Title or Position | SURGERY CENTER DIRECTOR
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Name | SANDRA JORDAN NEMETZ
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Credential | RN
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Telephone | 706-296-7932
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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