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General NPI Number Information
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NPI Number | 1326221003
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Entity Type | Organization
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Legal Business Name | SAN DIEGO LASIK INSTITUTE
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Dates
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Enumeration Date | 12/17/2007
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Last Update Date | 12/17/2007
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Provider Practice Location Address
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Address Line | 2020 CAMINO DEL RIO N STE 808
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City | SAN DIEGO
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State | CA
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Zip | 92108-1546
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Country | US
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Telephone | 619-298-2733
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Fax |
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Provider Business Mailing Address
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Address Line | 2020 CAMINO DEL RIO N SUITE 808
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City | SAN DIEGO
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State | CA
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Zip | 92108-1541
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Country | US
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Telephone | 619-298-2733
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. TONY H PHAM
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Credential | M.D.
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Telephone | 619-298-2733
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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 | A80739
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License Number State | CA
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