Healthcare Provider Details

I. General information

NPI: 1053353359
Provider Name (Legal Business Name): VISION SURGERY & LASER CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 06/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2435 NW KLINE ST
ROSEBURG OR
97471-1687
US

IV. Provider business mailing address

2435 NW KLINE ST
ROSEBURG OR
97470-1690
US

V. Phone/Fax

Practice location:
  • Phone: 541-672-2020
  • Fax: 541-673-8084
Mailing address:
  • Phone: 541-672-2020
  • Fax: 541-673-8084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number071532
License Number StateOR

VIII. Authorized Official

Name: DR. JON-MARC WESTON
Title or Position: OWNER
Credential: M.D.
Phone: 541-672-2020