Provider Demographics
NPI:1942967799
Name:ENVISION LASER CENTERS, LLC
Entity Type:Organization
Organization Name:ENVISION LASER CENTERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:VANCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-942-4001
Mailing Address - Street 1:332 W PLANK RD
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602-3016
Mailing Address - Country:US
Mailing Address - Phone:814-942-4001
Mailing Address - Fax:814-942-4001
Practice Address - Street 1:332 W PLANK RD
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-3016
Practice Address - Country:US
Practice Address - Phone:814-942-4001
Practice Address - Fax:814-942-4021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-29
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery