Organization
DESOTO EYE SURGERY CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ALAN R. SCHAEFFER M.D. (MANAGING MEMBER)
(662) 349-1959
Entity
Organization
Contact information
Practice address
726 GOODMAN RD E, SUITE B, SOUTHAVEN, MS 38671-9530
(662) 349-1959
(662) 349-0424
Mailing address
726 GOODMAN RD E, SUITE B, SOUTHAVEN, MS 38671-9530
(662) 349-1959
(662) 349-0424
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00959926
RAILROAD MEDICARE
MS
Enumeration date
03/11/2009
Last updated
04/05/2012
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