MEDICARE: ADVANCED LASER &EYE CENTER OF ARIZONA PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	22618	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1009192	OTHER	AZ	AETNA INS CO
2	33209	OTHER		EVERCARE
3	3Z3345	OTHER	AZ	HEALTHNET

General Provider Information

NPI Number	:	1245284934
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED LASER &EYE CENTER OF ARIZONA PC

Provider Business Mailing Address
First Line	:	3303 E BASELINE RD
Second Line	:	#104
City	:	GILBERT
State	:	AZ
Zip	:	85234-2739
Country	:	US
Telephone Number	:	480-632-2020
Fax Number	:	480-632-2121

Provider Business Practice Location Address
First Line	:	3303 E BASELINE RD
Second Line	:	#104
City	:	GILBERT
State	:	AZ
Zip	:	85234-2739
Country	:	US
Telephone Number	:	480-632-2020
Fax Number	:	480-632-2121

Authorized Official
Title or Position	:	OWNER PRESIDENT
Name	:	KIANOUSH KIAN
Credential	:	MD
Telephone Number	:	480-632-2020

Provider Enumeration Date	:	05/19/2006
Last Update Date	:	01/23/2013

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Directions to “ADVANCED LASER &EYE CENTER OF ARIZONA PC ” Practice Location

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