Organization
COLEMAN CATARACT AND EYE LASER SURGERY CENTER, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TARA E KELLY (INSURANCE REPRESENTATIVE)
(662) 455-4523
Entity
Organization
Contact information
Practice address
2005 HIGHWAY 82 W, GREENWOOD, MS 38930-2720
(662) 455-4523
(662) 455-3790
Mailing address
2005 HIGHWAY 82 W, GREENWOOD, MS 38930-2720
(662) 455-4523
(662) 455-3790
Taxonomy
Speciality
Code
Description
License number
State
261QS0132X
Ophthalmologic Surgery Clinic/Center
Primary
—
—
367500000X
Certified Registered Nurse Anesthetist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00770597
—
MS
01
—
490005565
RAILROAD MEDICARE
MS
Enumeration date
07/12/2005
Last updated
08/26/2008
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