Provider Demographics
NPI:1326221003
Name:SAN DIEGO LASIK INSTITUTE
Entity Type:Organization
Organization Name:SAN DIEGO LASIK INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TONY
Authorized Official - Middle Name:H
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-298-2733
Mailing Address - Street 1:2020 CAMINO DEL RIO N
Mailing Address - Street 2:SUITE 808
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-1541
Mailing Address - Country:US
Mailing Address - Phone:619-298-2733
Mailing Address - Fax:
Practice Address - Street 1:2020 CAMINO DEL RIO N STE 808
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-1546
Practice Address - Country:US
Practice Address - Phone:619-298-2733
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-17
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA80739207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty