Provider Demographics
NPI:1609247659
Name:LASER AND LIGHT SURGERY CENTER
Entity Type:Organization
Organization Name:LASER AND LIGHT SURGERY CENTER
Other - Org Name:HECTOR FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:HECTOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-300-4994
Mailing Address - Street 1:533 E COUNTY LINE RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-1073
Mailing Address - Country:US
Mailing Address - Phone:317-300-4994
Mailing Address - Fax:
Practice Address - Street 1:533 E COUNTY LINE RD
Practice Address - Street 2:SUITE 204
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-1073
Practice Address - Country:US
Practice Address - Phone:317-300-4994
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-16
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty