MEDICARE: COLUMBUS EYE CLINIC AND LASER SURGERY CENTER LTD

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	174400000X	Specialist

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	:	1982785846
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLUMBUS EYE CLINIC AND LASER SURGERY CENTER LTD

Provider Business Mailing Address
First Line	:	425 HOSPITAL DR
Second Line	:	SUITE 8
City	:	COLUMBUS
State	:	MS
Zip	:	39705-1938
Country	:	US
Telephone Number	:	662-328-2061
Fax Number	:	662-328-5000

Provider Business Practice Location Address
First Line	:	425 HOSPITAL DR
Second Line	:	SUITE 8
City	:	COLUMBUS
State	:	MS
Zip	:	39705-1938
Country	:	US
Telephone Number	:	662-328-2061
Fax Number	:	662-328-5000

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. WILLIAM M GILLESPIE III
Credential	:	M.D.
Telephone Number	:	662-328-2061

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	08/21/2013

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