Provider Demographics
NPI:1740413400
Name:ATLANTIC SURGERY & LASER CENTER LLC
Entity Type:Organization
Organization Name:ATLANTIC SURGERY & LASER CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KAUKWOK
Authorized Official - Middle Name:FREDERICK
Authorized Official - Last Name:HO
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:321-757-7272
Mailing Address - Street 1:8040 N WICKHAM RD
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-8298
Mailing Address - Country:US
Mailing Address - Phone:321-757-7272
Mailing Address - Fax:321-757-7273
Practice Address - Street 1:8040 N WICKHAM RD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-8298
Practice Address - Country:US
Practice Address - Phone:321-757-7272
Practice Address - Fax:321-757-7273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-28
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QA1903X
261QS0132X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF1544Medicare PIN