Healthcare Provider Details

I. General information

NPI: 1255473021
Provider Name (Legal Business Name): THE LASIK VISION INSTITUTE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 11/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 BURLINGTON MALL RD SUITE 101
BURLINGTON MA
01803-4537
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 781-505-1995
  • Fax: 781-505-1998
Mailing address:
  • Phone: 561-965-9110
  • Fax: 706-243-4627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

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