Basic Information
| Provider Information | |||||||||
| NPI: | 1073652541 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THE LASIK VISION INSTITUTE, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2000 PALM BEACH LAKES BLVD | ||||||||
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| City: | WEST PALM BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334096503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5619659110 | ||||||||
| FaxNumber: | 7062434627 | ||||||||
| Practice Location | |||||||||
| Address1: | 7501 W LAKE MEAD BLVD | ||||||||
| Address2: | STE 104 | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891280275 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7028045556 | ||||||||
| FaxNumber: | 7028041635 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/05/2007 | ||||||||
| LastUpdateDate: | 01/25/2013 | ||||||||
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| AuthorizedOfficialLastName: | COOK | ||||||||
| AuthorizedOfficialFirstName: | BEN | ||||||||
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| AuthorizedOfficialTitleorPosition: | COO | ||||||||
| AuthorizedOfficialTelephone: | 5619659110 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | C14-000283-4-094740 | NV | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
No ID Information.