MEDICARE: AUGUSTA EYE SURGERY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center

General Provider Information

NPI Number	:	1154449643
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AUGUSTA EYE SURGERY, LLC

Provider Business Mailing Address
First Line	:	905 STEVENS CREEK RD
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30907-3201
Country	:	US
Telephone Number	:	706-922-6000
Fax Number	:	706-722-7994

Provider Business Practice Location Address
First Line	:	905 STEVENS CREEK RD
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30907-3201
Country	:	US
Telephone Number	:	706-922-6000
Fax Number	:	706-722-7994

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. MICHELLE ROGERS
Credential	:	COE
Telephone Number	:	706-922-6000

Provider Enumeration Date	:	03/26/2007
Last Update Date	:	02/16/2010

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Directions to “AUGUSTA EYE SURGERY, LLC ” Practice Location

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