Provider Demographics
NPI:1114116167
Name:LASER VISION CENTERS INC.
Entity Type:Organization
Organization Name:LASER VISION CENTERS INC.
Other - Org Name:TLC LASER EYE CENTERS KENNESAW
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:636-534-2300
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:636-534-2300
Mailing Address - Fax:636-489-0206
Practice Address - Street 1:600 CHASTAIN RD NW
Practice Address - Street 2:SUITE 324
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-3020
Practice Address - Country:US
Practice Address - Phone:636-534-2300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-16
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center