| NPI | 1376104554 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSEPH CERAVOLO President 706-323-8127 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS0132X Clinic/Center, Ophthalmologic Surgery |
| Additional Taxonomies | 207W00000X Ophthalmology |
| 261QA1903X Clinic/Center, Ambulatory Surgical | |
| Enumeration Date | 2019-06-27 |
| Last Update Date | 2019-11-21 |