Provider Demographics
NPI:1235224619
Name:UNIVERSAL LASER TECHNOLOGIES, LLC
Entity Type:Organization
Organization Name:UNIVERSAL LASER TECHNOLOGIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:DUNLAP
Authorized Official - Suffix:
Authorized Official - Credentials:MLSO
Authorized Official - Phone:281-633-9167
Mailing Address - Street 1:2423 CANEY CREEK COURT
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77469
Mailing Address - Country:US
Mailing Address - Phone:281-633-9167
Mailing Address - Fax:281-633-8972
Practice Address - Street 1:2423 CANEY CREEK COURT
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77469
Practice Address - Country:US
Practice Address - Phone:281-633-9167
Practice Address - Fax:281-633-8972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXZ01520246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXZ01520OtherBUREAU OF RADIOLOGY #
TXHH1565OtherBLUE CROSS BLUE SHIELD