Basic Information
| Provider Information | |||||||||
| NPI: | 1508304577 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THE LASIK VISION INSTITUTE LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1555 PALM BEACH LAKES BLVD | ||||||||
| Address2: | SUITE 600 | ||||||||
| City: | WEST PALM BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334012323 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5619659110 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2900 CHARLEVOIX DR SE | ||||||||
| Address2: | SUITE # 100 | ||||||||
| City: | GRAND RAPIDS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 495467085 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6169428331 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/09/2017 | ||||||||
| LastUpdateDate: | 02/09/2017 | ||||||||
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| AuthorizedOfficialLastName: | COOK | ||||||||
| AuthorizedOfficialFirstName: | BEN | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| 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 | 261QS0132X | Y | Ambulatory Health Care Facilities | Clinic/Center | Ophthalmologic Surgery |
No ID Information.