Healthcare Provider Details

I. General information

NPI: 1689245011
Provider Name (Legal Business Name): DR. G. MARK LASKERR AND ASSOCIATES, O.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2021
Last Update Date: 07/07/2021
Certification Date: 07/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1929A W BRANDON BLVD
BRANDON FL
33511-4813
US

IV. Provider business mailing address

25812 GOLDTREE CT
WESLEY CHAPEL FL
33544-5113
US

V. Phone/Fax

Practice location:
  • Phone: 813-662-2200
  • Fax: 813-662-2140
Mailing address:
  • Phone: 813-713-6936
  • Fax: 863-413-0227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. GREGORY MARK LASKERR
Title or Position: PRES/CEO
Credential: OD
Phone: 813-713-6936