Provider Demographics
NPI:1104987957
Name:EYE SURGERY CENTER OF AUGUSTA, LLC
Entity type:Organization
Organization Name:EYE SURGERY CENTER OF AUGUSTA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-651-2020
Mailing Address - Street 1:3658 J DEWEY GRAY CIR
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-6424
Mailing Address - Country:US
Mailing Address - Phone:706-651-2020
Mailing Address - Fax:706-651-2032
Practice Address - Street 1:3658 J DEWEY GRAY CIR
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-6424
Practice Address - Country:US
Practice Address - Phone:706-651-3937
Practice Address - Fax:706-863-3102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA121167261QS0132X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
7300002OtherAETNA PPO, STANDARD
10040055OtherAMERIGROUP MGD MEDICAID
SCASC020Medicaid
2189908OtherAETNA HMO
324827OtherWELLCARE MANAGED MEDICAID
GA00830101AMedicaid
=========OtherTRICARE
7300002OtherAETNA PPO, STANDARD
=========OtherBCBSOF GEORGIA
GA00830101AMedicaid