1194969519 NPI number — LASER VISION INSTITUTE OF THE VIRGIN ISLANDS LLC

Table of content: (NPI 1194969519)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194969519 NPI number — LASER VISION INSTITUTE OF THE VIRGIN ISLANDS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LASER VISION INSTITUTE OF THE VIRGIN ISLANDS LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194969519
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/05/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8000 NISKY SHOPPING CTR STE 19B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ST THOMAS
Provider Business Mailing Address State Name:
VI
Provider Business Mailing Address Postal Code:
00802-5809
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
340-774-3003
Provider Business Mailing Address Fax Number:
866-896-5634

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8000 NISKY CTR.
Provider Second Line Business Practice Location Address:
STE 19B
Provider Business Practice Location Address City Name:
ST. THOMAS
Provider Business Practice Location Address State Name:
VI
Provider Business Practice Location Address Postal Code:
00802
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
340-774-3003
Provider Business Practice Location Address Fax Number:
866-896-5634
Provider Enumeration Date:
04/29/2009

Additional Information

Authorized Official

Authorized Official Last Name:
BARHAM
Authorized Official First Name:
MARCIA
Authorized Official Middle Name:
ALLAIN
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
340-774-3003

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  1005 , registered in the state of VI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QA1903X , with the licence number: 1005 , registered in the state of VI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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