Provider Demographics
NPI:1740624113
Name:LIGHTHOUSE LASERS INC
Entity type:Organization
Organization Name:LIGHTHOUSE LASERS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:MILLS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:855-989-2020
Mailing Address - Street 1:1300 SHORELINE DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32561-4765
Mailing Address - Country:US
Mailing Address - Phone:855-989-2020
Mailing Address - Fax:850-290-5952
Practice Address - Street 1:1300 SHORELINE DR
Practice Address - Street 2:SUITE 104
Practice Address - City:GULF BREEZE
Practice Address - State:FL
Practice Address - Zip Code:32561-4765
Practice Address - Country:US
Practice Address - Phone:855-989-2020
Practice Address - Fax:850-290-5952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-29
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL152W00000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty