Provider Demographics
NPI:1104030444
Name:TLC WHITTEN LASER EYE ASSOCIATES, LLC
Entity Type:Organization
Organization Name:TLC WHITTEN LASER EYE ASSOCIATES, LLC
Other - Org Name:TLC LASER EYE CENTERS FREDERICK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:ANDREW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-534-2360
Mailing Address - Street 1:16305 SWINGLEY RIDGE RD
Mailing Address - Street 2:STE. 300
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-1777
Mailing Address - Country:US
Mailing Address - Phone:636-534-2360
Mailing Address - Fax:
Practice Address - Street 1:70 THOMAS JOHNSON DR
Practice Address - Street 2:SUITE 120
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4361
Practice Address - Country:US
Practice Address - Phone:301-662-5190
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center