1295871374 NPI number — LASIKPLUS MEDICAL ASSOCIATES, INC

Table of content: (NPI 1295871374)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295871374 NPI number — LASIKPLUS MEDICAL ASSOCIATES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LASIKPLUS MEDICAL ASSOCIATES, INC
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:
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NPI Number Information

NPI Number:
1295871374
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7840 MONTGOMERY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45236-4301
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
950 TOWER LN
Provider Second Line Business Practice Location Address:
STE 130
Provider Business Practice Location Address City Name:
FOSTER CITY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94404-2121
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
650-286-8200
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/29/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
KIRK
Authorized Official First Name:
SCOTT
Authorized Official Middle Name:
Authorized Official Title or Position:
V.P. MANAGED CARE
Authorized Official Telephone Number:
800-688-4550

Provider Taxonomy Codes

  • Taxonomy code: 261QS0132X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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