Organization
LAIRCEY EYE SERVICES PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRENT C LAIRCEY OD (PRESIDENT)
(912) 489-3937
Entity
Organization
Contact information
Practice address
820 HWY 80 E, STATESBORO, GA 30461-0800
(912) 489-3937
Mailing address
820 HWY 80 E, STATESBORO, GA 30461-0800
(912) 489-3937
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPT 002175
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DD3540
RR MEDICARE GROUP
GA
01
—
GRP6825
MEDICARE GROUP
GA
01
—
P00223010
RR MEDICARE INDIVIDUAL
GA
Enumeration date
07/26/2007
Last updated
04/20/2008
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