Healthcare Provider Details

I. General information

NPI: 1952461840
Provider Name (Legal Business Name): LASER EYE INSTITUTE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 03/13/2023
Certification Date: 03/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1603 MEDICAL DR STE D
LAURINBURG NC
28352-5541
US

IV. Provider business mailing address

1603 MEDICAL DR STE D
LAURINBURG NC
28352-5541
US

V. Phone/Fax

Practice location:
  • Phone: 910-277-1411
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1100X
TaxonomyOphthalmic Technician/Technologist
License Number207W00000X
License Number StateNC

VIII. Authorized Official

Name: WANDA DEE MARCUM
Title or Position: OFFICE MANAGER
Credential:
Phone: 910-277-1411