MEDICARE: LAI VISION AND SURGERY, LLC

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	01074332A	IN

General Provider Information

NPI Number	:	1477903789
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAI VISION AND SURGERY, LLC

Provider Business Mailing Address
First Line	:	10300 N ILLINOIS ST STE 1000
Second Line	:
City	:	CARMEL
State	:	IN
Zip	:	46290-1167
Country	:	US
Telephone Number	:	317-805-2240
Fax Number	:	317-527-4708

Provider Business Practice Location Address
First Line	:	10300 N ILLINOIS ST STE 1000
Second Line	:
City	:	CARMEL
State	:	IN
Zip	:	46290-1167
Country	:	US
Telephone Number	:	317-805-2240
Fax Number	:	317-527-4708

Authorized Official
Title or Position	:	OWNER, PRESIDENT
Name	:	DR. KEVIN E LAI
Credential	:	M.D.
Telephone Number	:	918-808-3433

Provider Enumeration Date	:	06/16/2016
Last Update Date	:	03/18/2021

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