Provider Demographics
NPI:1760837322
Name:LASR CLINIC OF HENDERSON
Entity Type:Organization
Organization Name:LASR CLINIC OF HENDERSON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ISRAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:VILLASENOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-568-8450
Mailing Address - Street 1:7151 CASCADE VALLEY CT
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-0496
Mailing Address - Country:US
Mailing Address - Phone:702-568-8450
Mailing Address - Fax:702-568-8451
Practice Address - Street 1:200 E HORIZON DR
Practice Address - Street 2:SUITE A
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89015-8033
Practice Address - Country:US
Practice Address - Phone:702-568-8450
Practice Address - Fax:702-568-8451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-02
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
7565900001Medicare NSC