MEDICARE: LASER EYE CENTER INC

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	152W00000X	Optometrist
2	207W00000X	Ophthalmology Physician

General Provider Information

NPI Number	:	1417442500
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LASER EYE CENTER INC

Provider Business Mailing Address
First Line	:	1127 WILSHIRE BLVD STE 1216
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90017-4003
Country	:	US
Telephone Number	:	213-223-0130
Fax Number	:	213-223-0153

Provider Business Practice Location Address
First Line	:	1127 WILSHIRE BLVD STE 1209
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90017-4003
Country	:	US
Telephone Number	:	213-250-8888
Fax Number	:	213-250-7910

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ABRAHAM SHAMMAS
Credential	:	MD
Telephone Number	:	213-250-8888

Provider Enumeration Date	:	06/29/2018
Last Update Date	:	06/29/2018

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