Healthcare Provider Details

I. General information

NPI: 1134365505
Provider Name (Legal Business Name): VISION QUEST LASER CENTER, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2009
Last Update Date: 06/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5421 LA SIERRA DR
DALLAS TX
75231-4107
US

IV. Provider business mailing address

5421 LA SIERRA DR
DALLAS TX
75231-4107
US

V. Phone/Fax

Practice location:
  • Phone: 214-361-1443
  • Fax:
Mailing address:
  • Phone: 214-361-1443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number
License Number StateTX

VIII. Authorized Official

Name: WESLEY K HERMAN
Title or Position: OWNER
Credential: M.D.
Phone: 214-361-1443