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General NPI Number Information
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NPI Number | 1447387063
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Entity Type | Organization
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Legal Business Name | THE LASER NETWORK, LLC
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Dates
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Enumeration Date | 02/28/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1224 GREENWOOD AVE
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City | DEERFIELD
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State | IL
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Zip | 60015-2807
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Country | US
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Telephone | 847-948-5664
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Fax | 847-948-7304
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Provider Business Mailing Address
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Address Line | 1224 GREENWOOD AVE
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City | DEERFIELD
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State | IL
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Zip | 60015-2807
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Country | US
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Telephone | 847-948-5664
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Fax | 847-948-7304
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MS. JAYNE D KULHANEK
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Credential | MHSA
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Telephone | 847-948-5664
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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