Provider Demographics
NPI:1568588705
Name:PRADO VISION LASIK CENTER LLC
Entity Type:Organization
Organization Name:PRADO VISION LASIK CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:
Authorized Official - Last Name:PRADO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-931-0500
Mailing Address - Street 1:7522 N HIMES AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-3205
Mailing Address - Country:US
Mailing Address - Phone:813-931-0500
Mailing Address - Fax:813-936-2805
Practice Address - Street 1:7522 N HIMES AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-3205
Practice Address - Country:US
Practice Address - Phone:813-931-0500
Practice Address - Fax:813-936-2805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME64750207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty