Provider Demographics
NPI:1568630051
Name:ORANGE COAST LASER VISION CENTER, INC.
Entity Type:Organization
Organization Name:ORANGE COAST LASER VISION CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:HARLAN
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-251-1497
Mailing Address - Street 1:2646 DUPONT DR
Mailing Address - Street 2:SUITE 270
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612-8887
Mailing Address - Country:US
Mailing Address - Phone:949-251-1497
Mailing Address - Fax:949-251-1498
Practice Address - Street 1:2646 DUPONT DR
Practice Address - Street 2:SUITE 270
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92612-8887
Practice Address - Country:US
Practice Address - Phone:949-251-1497
Practice Address - Fax:949-251-1498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-18
Last Update Date:2008-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG076132261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center