# EDMOND LASER INSTITUTE L.L.C.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1316052517
- **Authorized official:** DR. HENRY J PEARCE M.D. (PRESIDENT/MEDICAL DIRECTOR)
- **Authorized official phone:** (405) 348-9797

## Contact information

- **Practice address:** 105 S BRYANT AVE, SUITE 105, EDMOND, OK 73034-6399
- **Practice address phone:** (405) 348-9797
- **Practice address fax:** (405) 348-9026
- **Mailing address:** 105 S BRYANT AVE, SUITE 105, EDMOND, OK 73034-6399
- **Mailing address phone:** (405) 348-9797
- **Mailing address fax:** (405) 348-9026

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 08/20/2006
- **Last updated:** 08/22/2020