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General NPI Number Information
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NPI Number | 1942967799
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Entity Type | Organization
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Legal Business Name | ENVISION LASER CENTERS, LLC
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Dates
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Enumeration Date | 11/29/2021
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Last Update Date | 11/29/2021
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Provider Practice Location Address
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Address Line | 332 W PLANK RD
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City | ALTOONA
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State | PA
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Zip | 16602-3016
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Country | US
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Telephone | 814-942-4001
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Fax | 814-942-4021
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Provider Business Mailing Address
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Address Line | 332 W PLANK RD
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City | ALTOONA
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State | PA
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Zip | 16602-3016
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Country | US
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Telephone | 814-942-4001
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Fax | 814-942-4001
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Authorized Official
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Title or Position | GENERAL MANAGER
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Name | DAVID VANCE
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Credential |
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Telephone | 814-942-4001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS0132X
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Taxonomy Name | Ophthalmologic Surgery Clinic/Center
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License Number |
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License Number State |
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