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General NPI Number Information
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NPI Number | 1538182472
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Entity Type | Organization
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Legal Business Name | WOODLANDS LASER CENTER LLP
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Dates
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Enumeration Date | 07/25/2006
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Last Update Date | 09/18/2012
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Provider Practice Location Address
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Address Line | 17450 ST LUKES WAY SUITE 100
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City | THE WOODLANDS
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State | TX
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Zip | 77384-8045
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Country | US
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Telephone | 281-363-3443
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Fax | 936-271-1361
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Provider Business Mailing Address
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Address Line | 17450 ST LUKES WAY SUITE 100
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City | THE WOODLANDS
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State | TX
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Zip | 77384-8045
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Country | US
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Telephone | 281-363-3443
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Fax | 936-271-1361
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MARK F MICHELETTI
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Credential |
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Telephone | 281-348-4615
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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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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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