MEDICARE: MED-LASER SURGICAL CENTER 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	261QS0132X	Ophthalmologic Surgery Clinic/Center	930000999	CA

General Provider Information

NPI Number	:	1538178256
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MED-LASER SURGICAL CENTER LLC

Provider Business Mailing Address
First Line	:	2446 W WHITTIER BLVD
Second Line	:
City	:	MONTEBELLO
State	:	CA
Zip	:	90640-3041
Country	:	US
Telephone Number	:	323-728-5500
Fax Number	:	323-728-4408

Provider Business Practice Location Address
First Line	:	2445 W WHITTIER BLVD
Second Line	:	SUITE #100
City	:	MONTEBELLO
State	:	CA
Zip	:	90640-3069
Country	:	US
Telephone Number	:	323-727-2550
Fax Number	:	323-727-2552

Authorized Official
Title or Position	:	OFFICER/AO
Name	:	ERIC BOON
Credential	:
Telephone Number	:	480-567-0269

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	02/02/2026

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