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General NPI Number Information
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NPI Number | 1457518771
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Entity Type | Organization
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Legal Business Name | CLEARLY LASIK, INC.
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Dates
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Enumeration Date | 05/22/2008
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Last Update Date | 05/22/2008
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Provider Practice Location Address
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Address Line | 1322 E MCANDREWS RD SUITE 103
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City | MEDFORD
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State | OR
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Zip | 97504-6177
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Country | US
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Telephone | 541-779-5232
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Fax | 541-779-5246
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Provider Business Mailing Address
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Address Line | 1322 E MCANDREWS RD SUITE 103
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City | MEDFORD
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State | OR
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Zip | 97504-6177
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Country | US
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Telephone | 541-779-5232
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Fax | 541-779-5246
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Authorized Official
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Title or Position | COO/CFO
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Name | CHRISTIAN MONEA
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Credential |
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Telephone | 425-525-2206
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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 | 26938
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License Number State | OR
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