Provider Demographics
NPI:1396011003
Name:LASER DEFINED VISION
Entity Type:Organization
Organization Name:LASER DEFINED VISION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KARL
Authorized Official - Middle Name:G
Authorized Official - Last Name:STONECIPHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-851-7500
Mailing Address - Street 1:PO BOX 39148
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27438-9148
Mailing Address - Country:US
Mailing Address - Phone:336-851-7500
Mailing Address - Fax:
Practice Address - Street 1:1002 N CHURCH ST STE 102
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1447
Practice Address - Country:US
Practice Address - Phone:336-854-4441
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-27
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1427172246OtherINDIVIDUAL NPI