Provider Demographics
NPI:1811932791
Name:LASER & SURGERY CENTER, LLC
Entity type:Organization
Organization Name:LASER & SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GRANT
Authorized Official - Middle Name:D
Authorized Official - Last Name:AAKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-456-3200
Mailing Address - Street 1:345 COLLEGE ST SE
Mailing Address - Street 2:SUITE A
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-1013
Mailing Address - Country:US
Mailing Address - Phone:360-456-7077
Mailing Address - Fax:360-357-4848
Practice Address - Street 1:345 COLLEGE ST SE
Practice Address - Street 2:SUITE A
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-1013
Practice Address - Country:US
Practice Address - Phone:360-456-7077
Practice Address - Fax:360-357-4848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA261QA1903X261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8859751Medicare ID - Type UnspecifiedPROVIDER ID NUMBER