Provider Demographics
NPI:1053388223
Name:THE OCULAR SURGERY CENTER, LLC
Entity type:Organization
Organization Name:THE OCULAR SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JANIE
Authorized Official - Middle Name:D
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-222-2154
Mailing Address - Street 1:1100 N MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-4701
Mailing Address - Country:US
Mailing Address - Phone:210-222-2154
Mailing Address - Fax:210-227-6056
Practice Address - Street 1:1100 N MAIN AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-4701
Practice Address - Country:US
Practice Address - Phone:210-222-2154
Practice Address - Fax:210-227-6056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-07
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000175261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX490000764OtherRAILROAD MEDICARE
TX085892001Medicaid
TX451072Medicare PIN