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General NPI Number Information
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NPI Number | 1720081664
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Entity Type | Organization
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Legal Business Name | HEATON LASER AND SURGERY CENTER L L C
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Dates
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Enumeration Date | 05/24/2005
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Last Update Date | 10/07/2025
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Provider Practice Location Address
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Address Line | 3355 EARL CAMPBELL PKWY
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City | TYLER
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State | TX
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Zip | 75701-8435
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Country | US
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Telephone | 903-526-0444
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Fax |
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Provider Business Mailing Address
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Address Line | 3355 EARL CAMPBELL PKWY
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City | TYLER
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State | TX
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Zip | 75701-8435
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Country | US
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Telephone | 903-526-0444
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Fax | 903-595-6650
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Authorized Official
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Title or Position | DRC
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Name | TERRAN L SMITH
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Credential |
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Telephone | 903-526-0444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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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 | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 000377
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License Number State | TX
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