481 ASC Project LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

140000588 Issued in CA

Legal business name

481 ASC PROJECT LLC

Doing business as

Eye MD Laser & Surgery Center LLC

Practice address

481 30TH St
Oakland, CA 94609-3209

Phone

(510) 835-4521

Fax

(510) 835-4223

NPI assigned

Jan 16, 2007

Last updated

Jul 9, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Richard H. Lee, M.D.

Title

Medical Director

Phone

(510) 835-4521

Specialties & licenses 1

Addresses

Other names 1

• Eye MD Laser & Surgery Center LLC Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1447301593. Details of each certification follow.

• CCN 05C0001449 Ambulatory surgical center · Active · Name & address match · Details

Ambulatory surgical center certification: CCN 05C0001449

Legal name

EYE MD LASER AND SURGERY CENTER

Certification status

Active

Provider type (POS)

Ambulatory surgical center

Participating since

Aug 31, 1999

Last certification

Apr 25, 2017

Ownership / control type

Proprietary

Facility address

481 30TH Street
Oakland, CA 94609

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

CLIA laboratory certificates

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Ernest James Langham, MD

  • Ophthalmology Physician
  • Oakland, CA
  • NPI 1659472827
  NPD (past)

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

{
    "created_epoch": "1168905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1373328000000",
    "number": "1447301593",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "481 30TH ST",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946093209",
            "telephone_number": "510-835-4521",
            "fax_number": "510-835-4223"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "481 30TH ST",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946093209",
            "telephone_number": "510-835-4521",
            "fax_number": "510-835-4223"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "481 ASC PROJECT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-16",
        "last_updated": "2013-07-09",
        "status": "A",
        "authorized_official_last_name": "LEE",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "H.",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "510-835-4521",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "CA",
            "license": "140000588",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eye MD Laser & Surgery Center LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Ambulatory Surgical Clinic/Center in Oakland, CA
• Providers in Oakland, CA by specialty
• Ambulatory Surgical Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.