Healthcare Provider Details

I. General information

NPI: 1346584497
Provider Name (Legal Business Name): THE LASIK VISION INSTITUTE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2012
Last Update Date: 11/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3595 GRANDVIEW PKWY SUITE 125
BIRMINGHAM AL
35243-1934
US

IV. Provider business mailing address

2000 PALM BEACH LAKES BLVD SUITE 800
WEST PALM BEACH FL
33409-6503
US

V. Phone/Fax

Practice location:
  • Phone: 561-965-9110
  • Fax: 706-243-4627
Mailing address:
  • Phone: 561-965-9110
  • Fax: 706-243-4627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. BEN COOK
Title or Position: PRESIDENT
Credential:
Phone: 561-965-9110