Healthcare Provider Details

I. General information

NPI: 1093779951
Provider Name (Legal Business Name): EYE SURGERY AND LASER CLINIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2006
Last Update Date: 06/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 LAKE CONCORD RD
CONCORD NC
28025-2926
US

IV. Provider business mailing address

500 LAKE CONCORD RD NE
CONCORD NC
28025-2926
US

V. Phone/Fax

Practice location:
  • Phone: 704-782-1127
  • Fax: 704-782-1207
Mailing address:
  • Phone: 704-782-1127
  • Fax: 704-782-1207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number87485
License Number StateNC

VIII. Authorized Official

Name: DR. DAVID K. HARPER
Title or Position: PRESIDENT
Credential: M. D.
Phone: 704-782-1127