Provider Demographics
NPI:1730441601
Name:AUBURN LASIK & EYE INSTITUTE, LLC
Entity type:Organization
Organization Name:AUBURN LASIK & EYE INSTITUTE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:FRANK
Authorized Official - Last Name:CERAVOLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-323-8127
Mailing Address - Street 1:1240 BROOKSTONE CENTRE PKWY
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-2954
Mailing Address - Country:US
Mailing Address - Phone:706-323-8127
Mailing Address - Fax:706-596-4849
Practice Address - Street 1:3021 FREDERICK RD
Practice Address - Street 2:STE 4
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36801-7145
Practice Address - Country:US
Practice Address - Phone:334-705-8803
Practice Address - Fax:334-705-8643
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-15
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS827TA355152W00000X
ALMD25848207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty