Provider Demographics
NPI:1386603173
Name:EYE CARE SURGERY CENTER, INC
Entity type:Organization
Organization Name:EYE CARE SURGERY CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:
Authorized Official - Last Name:HALEY
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:225-923-0960
Mailing Address - Street 1:10423 OLD HAMMOND HWY
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-8264
Mailing Address - Country:US
Mailing Address - Phone:225-923-0960
Mailing Address - Fax:225-923-3736
Practice Address - Street 1:10423 OLD HAMMOND HWY
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-8264
Practice Address - Country:US
Practice Address - Phone:225-923-0960
Practice Address - Fax:225-923-3736
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-21
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA92261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1428566Medicaid
LA20120OtherBLUE CROSS BLUE SHIELD
LA11010Medicare ID - Type Unspecified