Organization
AUGUSTA RETINA LASER SURGICARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN BECKER (CFO)
(914) 391-4921
Entity
Organization
Contact information
Practice address
3685 WHEELER RD, SUITE 202, AUGUSTA, GA 30909-6446
(706) 210-0305
(706) 210-0306
Mailing address
PO BOX 11407, BIRMINGHAM, AL 35246-8575
(864) 359-1308
(239) 496-3939
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000874794A
—
GA
05
—
ASC025
—
SC
Enumeration date
01/10/2006
Last updated
04/27/2026
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