Healthcare Provider Details

I. General information

NPI: 1952570962
Provider Name (Legal Business Name): GLOBAL LASER VISION MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2008
Last Update Date: 02/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6950 FRIARS RD STE 100
SAN DIEGO CA
92108-5107
US

IV. Provider business mailing address

6950 FRIARS RD STE 100
SAN DIEGO CA
92108-5107
US

V. Phone/Fax

Practice location:
  • Phone: 619-243-2444
  • Fax: 619-243-2443
Mailing address:
  • Phone: 619-243-2444
  • Fax: 619-243-2443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberG085172
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberG085172
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License NumberG081572
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code156FC0800X
TaxonomyContact Lens Technician/Technologist
License NumberG085172
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code156FC0801X
TaxonomyContact Lens Fitter
License NumberG085172
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code156FX1100X
TaxonomyOphthalmic Technician/Technologist
License NumberG085172
License Number StateCA
# 7
Primary TaxonomyN
Taxonomy Code156FX1101X
TaxonomyOphthalmic Assistant
License NumberG085172
License Number StateCA
# 8
Primary TaxonomyN
Taxonomy Code156FX1201X
TaxonomyOptometric Assistant Technician
License NumberG085172
License Number StateCA
# 9
Primary TaxonomyN
Taxonomy Code156FX1202X
TaxonomyOptometric Technician
License NumberG085172
License Number StateCA
# 10
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License NumberG085172
License Number StateCA
# 11
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberG085172
License Number StateCA

VIII. Authorized Official

Name: MR. FARZAD YAGHOUTI
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 619-243-2444