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General NPI Number Information
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NPI Number | 1114562626
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Entity Type | Organization
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Legal Business Name | LASERVUE, LLC
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Dates
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Enumeration Date | 11/08/2019
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Last Update Date | 11/08/2019
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Provider Practice Location Address
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Address Line | 5530 WISCONSIN AVE STE 1209
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City | CHEVY CHASE
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State | MD
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Zip | 20815-4301
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Country | US
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Telephone | 301-363-2450
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Fax | 301-363-2455
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Provider Business Mailing Address
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Address Line | 5530 WISCONSIN AVE STE 1209
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City | CHEVY CHASE
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State | MD
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Zip | 20815-4301
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Country | US
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Telephone | 301-363-2450
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Fax | 301-363-2455
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Authorized Official
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Title or Position | PRESIDENT
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Name | KOUROSH NAZARI
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Credential | MD
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Telephone | 407-470-9798
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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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