Provider Demographics
NPI:1851992051
Name:LAVEEN LASIK AND TOTAL EYECARE, LLC
Entity Type:Organization
Organization Name:LAVEEN LASIK AND TOTAL EYECARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TORRENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:WATKINS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:602-237-4777
Mailing Address - Street 1:7205 S 51ST AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:LAVEEN
Mailing Address - State:AZ
Mailing Address - Zip Code:85339-7326
Mailing Address - Country:US
Mailing Address - Phone:602-237-4777
Mailing Address - Fax:602-237-2105
Practice Address - Street 1:7205 S 51ST AVE STE 201
Practice Address - Street 2:
Practice Address - City:LAVEEN
Practice Address - State:AZ
Practice Address - Zip Code:85339-7326
Practice Address - Country:US
Practice Address - Phone:602-237-4777
Practice Address - Fax:602-237-2105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-04
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic SurgeryGroup - Multi-Specialty