=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477700029
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FLORIDA EYE AND LASER CENTER INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/26/2008
-----------------------------------------------------
Last Update Date | 08/26/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2001 N FEDERAL HWY STE.#206
-----------------------------------------------------
City | POMPANO BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33062-1030
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-942-3937
-----------------------------------------------------
Fax | 954-942-3904
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2001 N FEDERAL HWY STE.#206
-----------------------------------------------------
City | POMPANO BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33062-1030
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-942-3937
-----------------------------------------------------
Fax | 954-942-3904
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OPHTHALMOLOGIST
-----------------------------------------------------
Name | DR. LAVKUMAR HARIKRISHNA PANCHAL
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 954-942-3937
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM2500X
-----------------------------------------------------
Taxonomy Name | Medical Specialty Clinic/Center
-----------------------------------------------------
License Number | ME96010
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QS0132X
-----------------------------------------------------
Taxonomy Name | Ophthalmologic Surgery Clinic/Center
-----------------------------------------------------
License Number | ME96010
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------