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Organization
WESTON LASER & VISION INSTITUTE, INC
Active
Organization
WESTON LASER & VISION INSTITUTE, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SRINIVAS MUTYALA M.D. (MEDICAL DIRECTOR)
(954) 659-9051
Entity
Organization
Contact information
Practice address
2625 EXECUTIVE PARK DR, SUITE 4, WESTON, FL 33331-3634
(954) 659-9051
(954) 659-9052
Mailing address
2625 EXECUTIVE PARK DR, SUITE 4, WESTON, FL 33331-3634
(954) 659-9051
(954) 659-9052
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
ME0076746
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000408900
—
FL
05
—
000408901
—
FL
05
—
000408902
—
FL
Enumeration date
11/06/2007
Last updated
04/29/2024
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