Provider Demographics
NPI:1407969249
Name:LASER VISION USA, INC.
Entity Type:Organization
Organization Name:LASER VISION USA, INC.
Other - Org Name:ALASKA LASIK CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:W
Authorized Official - Last Name:COULTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:907-569-1551
Mailing Address - Street 1:235 E 8TH AVE STE 3A
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99501-3662
Mailing Address - Country:US
Mailing Address - Phone:907-569-1551
Mailing Address - Fax:907-569-1564
Practice Address - Street 1:235 E 8TH AVE STE 3A
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99501-3662
Practice Address - Country:US
Practice Address - Phone:907-569-1551
Practice Address - Fax:907-569-1564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK4540207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK205382205382OtherBLUE CROSS BLUE SHIELD
AKGRP4536OtherPROVIDENCE HEALTH PLANS
AKMD2963Medicaid
AK152049Medicare ID - Type Unspecified