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General NPI Number Information
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NPI Number | 1508069493
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Entity Type | Organization
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Legal Business Name | THE LASER CENTER
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Dates
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Enumeration Date | 06/07/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 10809 EXECUTIVE CENTER DR STE 201
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City | LITTLE ROCK
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State | AR
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Zip | 72211-4353
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Country | US
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Telephone | 501-588-0072
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Fax |
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Provider Business Mailing Address
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Address Line | 104 NIXON LN
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City | AUSTIN
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State | AR
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Zip | 72007-0938
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Country | US
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Telephone | 501-941-0291
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Fax |
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Authorized Official
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Title or Position | REGIONAL MANAGER
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Name | DR. DAWN HOLSTED UPSHAW
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Credential | O.D.
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Telephone | 405-842-6060
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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 | 2585
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License Number State | AR
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