Provider Demographics
NPI:1821137340
Name:THE LASIK VISION INSTITUTE LLC
Entity Type:Organization
Organization Name:THE LASIK VISION INSTITUTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:BEN
Authorized Official - Middle Name:
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-965-9110
Mailing Address - Street 1:2000 PALM BEACH LAKES BLVD
Mailing Address - Street 2:STE 800
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409-6503
Mailing Address - Country:US
Mailing Address - Phone:561-965-9110
Mailing Address - Fax:706-243-4627
Practice Address - Street 1:8881 FLETCHER PKWY
Practice Address - Street 2:SUITE 395
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-3134
Practice Address - Country:US
Practice Address - Phone:619-593-7284
Practice Address - Fax:619-593-7391
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB2004006352152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty