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General NPI Number Information
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NPI Number | 1669513388
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Entity Type | Organization
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Legal Business Name | THE LASIK VISION INSTITUTE LLC
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Dates
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Enumeration Date | 02/08/2007
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Last Update Date | 11/17/2011
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Provider Practice Location Address
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Address Line | 4750 BRYANT IRVIN RD STE 812
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City | FORT WORTH
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State | TX
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Zip | 76132-3633
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Country | US
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Telephone | 817-263-6798
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Fax | 817-263-6797
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Provider Business Mailing Address
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Address Line | 2000 PALM BEACH LAKES BLVD STE 800
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City | WEST PALM BEACH
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State | FL
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Zip | 33409-6503
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Country | US
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Telephone | 561-965-9110
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Fax | 706-243-4627
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Authorized Official
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Title or Position | COO
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Name | BEN COOK
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Credential |
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Telephone | 561-965-9110
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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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