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General NPI Number Information
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NPI Number | 1073087706
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Entity Type | Organization
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Legal Business Name | LASER SIGHT, LP
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Dates
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Enumeration Date | 01/16/2019
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Last Update Date | 01/16/2019
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Provider Practice Location Address
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Address Line | 6500 N MO PAC EXPY STE 2101
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City | AUSTIN
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State | TX
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Zip | 78731-3282
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Country | US
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Telephone | 512-346-3937
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Fax | 512-346-8477
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Provider Business Mailing Address
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Address Line | 6500 N MO PAC EXPY STE 2101
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City | AUSTIN
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State | TX
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Zip | 78731-3282
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Country | US
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Telephone | 512-346-3937
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Fax | 512-346-8477
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Authorized Official
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Title or Position | CENTER DIRECTOR
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Name | MR. CHAD NICHOLAS JACKSON
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Credential |
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Telephone | 512-346-3937
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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