Provider Demographics
NPI:1720278203
Name:LASIK PRO PA
Entity Type:Organization
Organization Name:LASIK PRO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DENBESTE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:407-245-3636
Mailing Address - Street 1:105 BONNIE LOCH CT
Mailing Address - Street 2:SUITE A
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-2909
Mailing Address - Country:US
Mailing Address - Phone:407-245-3636
Mailing Address - Fax:407-245-3667
Practice Address - Street 1:105 BONNIE LOCH CT
Practice Address - Street 2:SUITE A
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-2909
Practice Address - Country:US
Practice Address - Phone:407-245-3636
Practice Address - Fax:407-245-3667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-31
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC1632152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAF949Medicare PIN