Healthcare Provider Details

I. General information

NPI: 1720156482
Provider Name (Legal Business Name): LASER & SURGICAL EYE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 10/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1333 E BARNETT RD
MEDFORD OR
97504-8219
US

IV. Provider business mailing address

1333 E BARNETT RD
MEDFORD OR
97504-8219
US

V. Phone/Fax

Practice location:
  • Phone: 541-779-4711
  • Fax: 541-618-1485
Mailing address:
  • Phone: 541-779-4711
  • Fax: 541-618-1485

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: KEITH CASEBOLT
Title or Position: CEO
Credential:
Phone: 541-779-4711