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General NPI Number Information
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NPI Number | 1649401563
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Entity Type | Organization
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Legal Business Name | MEDICAL LASER CENTER LLC
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Dates
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Enumeration Date | 07/28/2009
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Last Update Date | 11/24/2025
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Provider Practice Location Address
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Address Line | 133 PLAZA DR SUITE 3
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City | BEREA
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State | KY
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Zip | 40403-2087
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Country | US
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Telephone | 859-986-1370
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Fax | 859-986-1374
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Provider Business Mailing Address
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Address Line | 133 PLAZA DR SUITE 3
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City | BEREA
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State | KY
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Zip | 40403-2087
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Country | US
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Telephone | 859-986-1370
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Fax | 859-986-1374
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Authorized Official
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Title or Position | OWNER
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Name | DR. NAWAR SODA
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Credential | MD
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Telephone | 859-986-1370
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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