# EYE SURGICAL ASSOCIATES P C

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1669648879
- **Authorized official:** DR. JOHN KENNETH WALLACE MD (PRESIDENT)
- **Authorized official phone:** (334) 699-2244

## Contact information

- **Practice address:** 2664 HARTFORD HWY, DOTHAN, AL 36305-4904
- **Practice address phone:** (334) 699-2244
- **Practice address fax:** (334) 699-2245
- **Mailing address:** 2664 HARTFORD HWY, DOTHAN, AL 36305-4904
- **Mailing address phone:** (334) 699-2244
- **Mailing address fax:** (334) 699-2245

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207W00000X | Ophthalmology Physician | 13178 | AL | Yes |

## Other

- **Enumeration date:** 05/07/2008
- **Last updated:** 11/17/2011