MEDICARE: MISSISSIPPI EYE SURGERY CENTER UC

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	261QA0900X	Amputee Clinic/Center		MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1609809326
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MISSISSIPPI EYE SURGERY CENTER UC

Provider Business Mailing Address
First Line	:	3432 BIENVILLE BLVD
Second Line	:
City	:	OCEAN SPRINGS
State	:	MS
Zip	:	39564
Country	:	US
Telephone Number	:	228-244-0067
Fax Number	:	228-244-0071

Provider Business Practice Location Address
First Line	:	3432 BIENVILLE BLVD
Second Line	:
City	:	OCEAN SPRINGS
State	:	MS
Zip	:	39564
Country	:	US
Telephone Number	:	228-244-0067
Fax Number	:	228-244-0071

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MS. SANDY ROBERTSON
Credential	:	RN
Telephone Number	:	228-244-0067

Provider Enumeration Date	:	07/08/2006
Last Update Date	:	08/05/2008

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