Provider Demographics
NPI:1073652541
Name:THE LASIK VISION INSTITUTE, LLC
Entity Type:Organization
Organization Name:THE LASIK VISION INSTITUTE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:BEN
Authorized Official - Middle Name:
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-965-9110
Mailing Address - Street 1:2000 PALM BEACH LAKES BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409-6503
Mailing Address - Country:US
Mailing Address - Phone:561-965-9110
Mailing Address - Fax:706-243-4627
Practice Address - Street 1:7501 W LAKE MEAD BLVD
Practice Address - Street 2:STE 104
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0275
Practice Address - Country:US
Practice Address - Phone:702-804-5556
Practice Address - Fax:702-804-1635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVC14-000283-4-094740152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty