Eye Laser and Surgery Center LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

0991AS Issued in OH

Legal business name

EYE LASER AND SURGERY CENTER LLC

Practice address

4235 Indian Ripple Rd
Ste 110
Beavercreek, OH 45440-3265

Phone

(937) 427-7800

Fax

(937) 427-7803

NPI assigned

May 7, 2010

Organization subpart

No

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

Authorized official

Name

Brian R Stahl, M.D.NPI 1942202700

Title

Managing Partner/President

Phone

(937) 427-2020

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OH

Enrollment records 1

Listed as

Eye Laser and Surgery Center LLCCCN 36C0001265

Medicare certification status

ActiveFrom the Provider of Services file

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 3

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

• John Francis Gillis II, M.D.

  • Ophthalmology Physician
  • Wright Patterson Afb, OH
  • NPI 1083970628
  Medicare reassignment NPD
• Maneesh K Mehan, M.D.

  • Ophthalmology Physician
  • Dayton, OH
  • NPI 1386751949
  Medicare reassignment NPD
• Brian Ray Stahl, M.D.

  • Ophthalmology Physician
  • Beavercreek, OH
  • NPI 1942202700
  NPD (past) Authorized official

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

{
    "created_epoch": "1273190400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1357776000000",
    "number": "1578881009",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4235 INDIAN RIPPLE RD",
            "address_2": "STE 110",
            "city": "BEAVERCREEK",
            "state": "OH",
            "postal_code": "454403265",
            "telephone_number": "937-427-7800",
            "fax_number": "937-427-7803"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4235 INDIAN RIPPLE RD",
            "address_2": "STE 110",
            "city": "BEAVERCREEK",
            "state": "OH",
            "postal_code": "454403265",
            "telephone_number": "937-427-7800",
            "fax_number": "937-427-7803"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EYE LASER AND SURGERY CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-05-07",
        "last_updated": "2013-01-10",
        "status": "A",
        "authorized_official_last_name": "STAHL",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "MANAGING PARTNER/PRESIDENT",
        "authorized_official_telephone_number": "937-427-2020",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "OH",
            "license": "0991AS",
            "primary": true
        },
        {
            "code": "261QS0132X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ophthalmologic Surgery",
            "state": "OH",
            "license": "0991AS",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0055714",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Audra Elizabeth Evans, LMT
• Carrie Lynn Evans, CNP
• Celia Carpenter Everett, PHARMD
• Jon Robert Ewig, D.D.S.
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• Ambulatory Surgical Clinic/Center in Beavercreek, OH
• Providers in Beavercreek, OH by specialty
• Ambulatory Surgical Clinic/Center in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.