Provider Demographics
NPI:1952461840
Name:LASER EYE INSTITUTE PA
Entity Type:Organization
Organization Name:LASER EYE INSTITUTE PA
Other - Org Name:THE LASER EYE INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:DEE
Authorized Official - Last Name:MARCUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-277-1411
Mailing Address - Street 1:1603 MEDICAL DR STE D
Mailing Address - Street 2:
Mailing Address - City:LAURINBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28352-5541
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1603 MEDICAL DR STE D
Practice Address - Street 2:
Practice Address - City:LAURINBURG
Practice Address - State:NC
Practice Address - Zip Code:28352-5541
Practice Address - Country:US
Practice Address - Phone:910-277-1411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC207W00000X156FX1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1100XEye and Vision Services ProvidersTechnician/TechnologistOphthalmicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8911517Medicaid
SCN00585Medicaid
NC0109AOtherBCBS OF NC
NC8911517Medicaid
SCN00585Medicaid
NC2325804AMedicare PIN