Provider Demographics
NPI:1942523139
Name:ADVANCED LASER CENTER
Entity Type:Organization
Organization Name:ADVANCED LASER CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:HUAN
Authorized Official - Last Name:PHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-296-0103
Mailing Address - Street 1:350 S WINCHESTER BLVD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-2092
Mailing Address - Country:US
Mailing Address - Phone:408-296-0103
Mailing Address - Fax:408-296-1795
Practice Address - Street 1:350 S WINCHESTER BLVD
Practice Address - Street 2:SUITE 250
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-2092
Practice Address - Country:US
Practice Address - Phone:408-296-0102
Practice Address - Fax:408-296-1795
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GREGORY HUAN PHAN MD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-03-02
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG77619261QS0132X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery