Provider Demographics
NPI:1255589198
Name:COLUMBUS LASER & VISION INSTITUTE
Entity type:Organization
Organization Name:COLUMBUS LASER & VISION INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:V.P.
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:COLUMBUS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:570-499-5851
Mailing Address - Street 1:4626 STREET RD.
Mailing Address - Street 2:
Mailing Address - City:TREVOSE
Mailing Address - State:PA
Mailing Address - Zip Code:19053-6612
Mailing Address - Country:US
Mailing Address - Phone:866-600-3937
Mailing Address - Fax:215-354-9444
Practice Address - Street 1:4626 STREET RD
Practice Address - Street 2:
Practice Address - City:TREVOSE
Practice Address - State:PA
Practice Address - Zip Code:19053-6612
Practice Address - Country:US
Practice Address - Phone:866-600-3937
Practice Address - Fax:215-354-9444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-04
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207W00000X
PA207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty