| Organization Name: | DESOTO EYE SURGERY CENTER LLC |
| NPI Number: | 1073754602 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ALAN R. SCHAEFFER (MANAGING MEMBER) |
| Mailing Address: | 726 Goodman Rd E Suite B Southaven |
| State: | MS US |
| Postal Code: | 386719530 |
| Phone Number: | 6623491959 |
| Fax Number: | 6623490424 |
| NPI Enumeration Date: | 03/11/2009 |
| NPI Last Update Date: | 04/05/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QA1903X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Ambulatory Surgical |
| Taxonomy Definition: | |