Provider Demographics
NPI:1669772893
Name:ADVANCED EYE SURGERY CENTER, L.L.C.
Entity type:Organization
Organization Name:ADVANCED EYE SURGERY CENTER, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CMO
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:GIRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:636-227-2600
Mailing Address - Street 1:15933 CLAYTON RD STE 210
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63011-2172
Mailing Address - Country:US
Mailing Address - Phone:636-227-2600
Mailing Address - Fax:
Practice Address - Street 1:1602 W 15TH AVE
Practice Address - Street 2:SUITE A
Practice Address - City:EMPORIA
Practice Address - State:KS
Practice Address - Zip Code:66801-5672
Practice Address - Country:US
Practice Address - Phone:620-343-7200
Practice Address - Fax:620-342-7895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-21
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS30003887780001Medicaid