Organization Active NPI

Augusta Retina Laser Surgicare

  • Ambulatory Surgical Clinic/Center
  • Augusta, GA
National Provider Identifier
1235118043
Registry record updated Apr 27, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
Legal business name
AUGUSTA RETINA LASER SURGICARE
Practice address
3685 Wheeler Rd
Suite 202
Augusta, GA 30909-6446
Phone
(706) 210-0305
Fax
(706) 210-0306
NPI assigned
Jan 10, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 27, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Kevin Becker
Title
Cfo
Phone
(914) 391-4921

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X GA Primary

Addresses

Primary practice location

3685 Wheeler Rd
Suite 202
Augusta, GA 30909-6446

Mailing address

PO Box 11407
Birmingham, AL 35246-8575
Phone (864) 359-1308

Other identifiers 2

IdentifierTypeStateIssuer
ASC025MedicaidSC
000874794AMedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120228000589 GA Part B Supplier - Ambulatory Surgical Center 7810155462 Receives reassigned benefits from 1 practitioner
Practice locations: Augusta, GA

Ambulatory surgical center certification: CCN 11C0001167

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
AUGUSTA RETINA-LASER SURGICARE
Certification status
Active
Provider type (POS)
Ambulatory surgical center
Participating since
Jun 1, 2000
Last certification
Nov 14, 2017
Ownership / control type
Proprietary
Facility address
3685 Wheeler Road, Suite 202
Augusta, GA 30909

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
11D0960343Augusta Retina-Laser Surgicare3685 Wheeler Rd Ste 202, Augusta, GA 30909Certificate of waiverMay 6, 2027

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1136851200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1777248000000",
    "number": "1235118043",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 11407",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352468575",
            "telephone_number": "864-359-1308",
            "fax_number": "239-496-3939"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3685 WHEELER RD",
            "address_2": "SUITE 202",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309096446",
            "telephone_number": "706-210-0305",
            "fax_number": "706-210-0306"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AUGUSTA RETINA LASER SURGICARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-10",
        "last_updated": "2026-04-27",
        "certification_date": "2026-04-27",
        "status": "A",
        "authorized_official_last_name": "BECKER",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "914-391-4921"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "GA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ASC025",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000874794A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Augusta, GA

Sources for this page

Verify at the official NPI Registry.