Provider Demographics
NPI:1275724684
Name:LASER AND REFRACTIVE
Entity Type:Organization
Organization Name:LASER AND REFRACTIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:C
Authorized Official - Last Name:HOOPES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-568-0200
Mailing Address - Street 1:11820 S STATE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-9737
Mailing Address - Country:US
Mailing Address - Phone:801-568-0200
Mailing Address - Fax:801-563-0200
Practice Address - Street 1:11820 S STATE
Practice Address - Street 2:100
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-9737
Practice Address - Country:US
Practice Address - Phone:801-568-0200
Practice Address - Fax:801-563-0200
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOOPES VISION CORRECTION CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-09
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4728718-0160261QS0132X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery