Provider Demographics
NPI:1821010638
Name:CATARACT AND LASER CENTER LLC
Entity Type:Organization
Organization Name:CATARACT AND LASER CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:LUZETSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-454-8800
Mailing Address - Street 1:4102 OGLETOWN STANTON RD
Mailing Address - Street 2:STE 1
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-4169
Mailing Address - Country:US
Mailing Address - Phone:302-454-8800
Mailing Address - Fax:302-454-8801
Practice Address - Street 1:4102 OGLETOWN STANTON RD
Practice Address - Street 2:SUITE 1
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-4169
Practice Address - Country:US
Practice Address - Phone:302-454-8802
Practice Address - Fax:302-454-8801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-24
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEFSSC004261Q00000X
DEFSSC004A261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1770A6OtherBLUE CROSS BLUE SHIELD DE
0002103000OtherIND BS
DE200079341Medicaid
DE1770A6OtherBLUE CROSS BLUE SHIELD DE