Provider Demographics
NPI:1093779951
Name:EYE SURGERY AND LASER CLINIC, INC.
Entity Type:Organization
Organization Name:EYE SURGERY AND LASER CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:K
Authorized Official - Last Name:HARPER
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:704-782-1127
Mailing Address - Street 1:500 LAKE CONCORD RD NE
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-2926
Mailing Address - Country:US
Mailing Address - Phone:704-782-1127
Mailing Address - Fax:704-782-1207
Practice Address - Street 1:500 LAKE CONCORD RD
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2926
Practice Address - Country:US
Practice Address - Phone:704-782-1127
Practice Address - Fax:704-782-1207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-17
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC87485261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC00618OtherBLUE CROSS BLUE SHIELD
NC805608OtherPARTNERS MEDICARE
NC3409839Medicaid
NC490005261Medicare PIN
NC2380010Medicare PIN