Organization
ACADEMY OF CATARACT AND LASER SURGERY, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HOWARD LEON BRUCKNER (DIRECTOR)
(706) 722-9601
Entity
Organization
Contact information
Practice address
909 15TH ST, AUGUSTA, GA 30901-2607
(706) 722-9601
Mailing address
909 15TH ST, AUGUSTA, GA 30901-2607
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
014605
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
014605
GA STATE LICENSE
GA
01
—
240279
BLUE CROSS OF GA
GA
Enumeration date
01/29/2007
Last updated
08/22/2020
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