Provider Demographics
NPI:1063622751
Name:SUARES EYE CENTER INC
Entity type:Organization
Organization Name:SUARES EYE CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:N
Authorized Official - Last Name:SUARES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:662-334-8578
Mailing Address - Street 1:344 ARNOLD AVE
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38701-4711
Mailing Address - Country:US
Mailing Address - Phone:662-334-8578
Mailing Address - Fax:662-334-8563
Practice Address - Street 1:344 ARNOLD AVE
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MS
Practice Address - Zip Code:38701-4711
Practice Address - Country:US
Practice Address - Phone:662-334-8578
Practice Address - Fax:662-334-8563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS06256207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00554511Medicaid
MS00554511Medicaid
MSDE1802Medicare UPIN