Healthcare Provider Details

I. General information

NPI: 1699817403
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

7550 TEAGUE RD SUITE 105
HANOVER MD
21076-1200
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 410-799-7345
  • Fax: 410-799-3086
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