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Organization
LASIK PROVISION, PC
Active
Organization
LASIK PROVISION, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JESSE ANDREW REAP (CLINIC DIRECTOR)
(315) 295-3937
Entity
Organization
Contact information
Practice address
5792 WIDEWATERS PKWY, DE WITT, NY 13214-1847
(315) 295-3937
Mailing address
5792 WIDEWATERS PKWY, DE WITT, NY 13214-1847
(315) 295-3937
Taxonomy
Speciality
Code
Description
License number
State
152WC0802X
Corneal and Contact Management Optometrist
Primary
TUV005851-1
NY
Other
Enumeration date
11/01/2007
Last updated
11/01/2007
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