Healthcare Provider Details

I. General information

NPI: 1043758022
Provider Name (Legal Business Name): THE LASIK VISION INSTITUTE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2017
Last Update Date: 02/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 RICHARDS AVE 6TH FLOOR
NORWALK CT
06854-2319
US

IV. Provider business mailing address

1555 PALM BEACH LAKES BLVD SUITE 600
WEST PALM BEACH FL
33401-2323
US

V. Phone/Fax

Practice location:
  • Phone: 203-299-0841
  • Fax:
Mailing address:
  • Phone: 561-965-9110
  • Fax:

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