Provider Demographics
NPI:1518266568
Name:EXCEL LASER VISION INSTITUTE
Entity Type:Organization
Organization Name:EXCEL LASER VISION INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:FERZAAD
Authorized Official - Middle Name:
Authorized Official - Last Name:MOOSA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-907-8606
Mailing Address - Street 1:16542 VENTURA BLVD.
Mailing Address - Street 2:SUITE 400
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-5045
Mailing Address - Country:US
Mailing Address - Phone:818-907-8606
Mailing Address - Fax:818-379-9786
Practice Address - Street 1:16542 VENTURA BLVD
Practice Address - Street 2:400
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2005
Practice Address - Country:US
Practice Address - Phone:818-907-8606
Practice Address - Fax:818-379-9786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-16
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA60007261QS0132X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery