Provider Demographics
NPI:1013114206
Name:GLAUCOMA & LASER SURGERY ASSOC INC.
Entity Type:Organization
Organization Name:GLAUCOMA & LASER SURGERY ASSOC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:B
Authorized Official - Last Name:WISE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-945-9747
Mailing Address - Street 1:3435 NW 56TH
Mailing Address - Street 2:#1010A
Mailing Address - City:OK
Mailing Address - State:OK
Mailing Address - Zip Code:73112
Mailing Address - Country:US
Mailing Address - Phone:405-945-4747
Mailing Address - Fax:405-945-4748
Practice Address - Street 1:3435 NW 56TH
Practice Address - Street 2:#1010A
Practice Address - City:OK
Practice Address - State:OK
Practice Address - Zip Code:73112
Practice Address - Country:US
Practice Address - Phone:405-945-4747
Practice Address - Fax:405-945-4748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-29
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty