Provider Demographics
NPI:1255518312
Name:SAN DIEGO AND ORANGE COUNTY LASIK INSTITUTE
Entity type:Organization
Organization Name:SAN DIEGO AND ORANGE COUNTY LASIK INSTITUTE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TONY
Authorized Official - Middle Name:HUY
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-298-2733
Mailing Address - Street 1:2020 CAMINO DEL RIO N STE 808
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-1546
Mailing Address - Country:US
Mailing Address - Phone:619-298-2733
Mailing Address - Fax:
Practice Address - Street 1:2020 CAMINO DEL RIO N STE 808
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-1546
Practice Address - Country:US
Practice Address - Phone:619-298-2733
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-30
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA87039207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty