Organization Name:  EYE SURGERY CENTER OF SAINT AUGUSTINE INC


Practice Location:
1400 US HIGHWAY 1 S  ST AUGUSTINE, FL 32084 US
Tel: 904-829-2344  Fax: --

Business Mailing Address:
  ,   
Tel: --  Fax: --


Taxonomy:

Primary	Code	Category/Description	State	License Number
Y	261QA1903X	Ambulatory Health Care Facilities Clinic/Center Ambulatory Surgical	FL	F1416

Other Provider Identifiers:

Issuer	Number	State	Type
14960504	AHCA ID NUMBER	FL	01
6G6	BLUE CROSS BLUE SHIE	FL	01
	075723300	FL	05
1195	LICENSE NUMBER	FL	01

Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin