Provider Demographics
NPI:1952982886
Name:OCULOFACIAL SURGERY AND COSMETIC LASER INSTITUTE LLC
Entity Type:Organization
Organization Name:OCULOFACIAL SURGERY AND COSMETIC LASER INSTITUTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSHNI
Authorized Official - Middle Name:U
Authorized Official - Last Name:RANJIT-REEVES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-303-0123
Mailing Address - Street 1:24420 STATE ROAD 54
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33559-7303
Mailing Address - Country:US
Mailing Address - Phone:813-303-0123
Mailing Address - Fax:813-587-9861
Practice Address - Street 1:24420 STATE ROAD 54
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33559-7303
Practice Address - Country:US
Practice Address - Phone:813-303-0123
Practice Address - Fax:813-587-9861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-21
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0200XAllopathic & Osteopathic PhysiciansOphthalmologyOphthalmic Plastic and Reconstructive SurgeryGroup - Single Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty