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General NPI Number Information
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NPI Number | 1528080876
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Entity Type | Organization
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Legal Business Name | FRY EYE SURGERY CENTER, LLC
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Dates
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Enumeration Date | 07/24/2006
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Last Update Date | 08/10/2015
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Provider Practice Location Address
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Address Line | 411 CAMPUS DRIVE
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City | GARDEN CITY
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State | KS
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Zip | 67846-6124
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Country | US
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Telephone | 620-276-7699
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Fax | 620-276-7704
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Provider Business Mailing Address
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Address Line | 411 CAMPUS DRIVE
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City | GARDEN CITY
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State | KS
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Zip | 67846-6124
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Country | US
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Telephone | 620-276-7699
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Fax | 620-276-7704
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL/OWNER
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Name | DR. WILLIAM S CLIFFORD
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Credential | M.D.
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Telephone | 620-275-7248
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty 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 | 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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