Organization
EYE LASER AND SURGERY CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRIAN R STAHL M.D. (MANAGING PARTNER/PRESIDENT)
(937) 427-2020
Entity
Organization
Contact information
Practice address
4235 INDIAN RIPPLE RD, STE 110, BEAVERCREEK, OH 45440-3265
(937) 427-7800
(937) 427-7803
Mailing address
4235 INDIAN RIPPLE RD, STE 110, BEAVERCREEK, OH 45440-3265
(937) 427-7800
(937) 427-7803
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
0991AS
OH
261QS0132X
Ophthalmologic Surgery Clinic/Center
0991AS
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0055714
—
OH
Enumeration date
05/07/2010
Last updated
01/10/2013
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