MEDICARE: ACADEMY OF CATARACT AND LASER SURGERY, PC

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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1598801045
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACADEMY OF CATARACT AND LASER SURGERY, PC

Provider Business Mailing Address
First Line	:	909 15TH ST
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30901-2607
Country	:	US
Telephone Number	:	706-722-9601
Fax Number	:

Provider Business Practice Location Address
First Line	:	909 15TH ST
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30901-2607
Country	:	US
Telephone Number	:	706-722-9601
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	HOWARD LEON BRUCKNER
Credential	:
Telephone Number	:	706-722-9601

Provider Enumeration Date	:	01/30/2007
Last Update Date	:	09/26/2008

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