Provider Demographics
NPI:1669599155
Name:DENNY EYE AND LASER CENTER
Entity type:Organization
Organization Name:DENNY EYE AND LASER CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER MEDICAL PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:DENNY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-567-8200
Mailing Address - Street 1:2201 WEBSTER STREET
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115
Mailing Address - Country:US
Mailing Address - Phone:415-567-8200
Mailing Address - Fax:415-567-2973
Practice Address - Street 1:711 VAN NESS AVE STE 300
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-3286
Practice Address - Country:US
Practice Address - Phone:415-567-8200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG44848207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherTAX ID
CA=========OtherTAX ID
00G448480Medicare ID - Type Unspecified
CAA49775Medicare UPIN