# MELBOURNE UNITED LASER VISION ASSOCIATION LLC

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

## Provider details

- **NPI number:** 1891787446
- **Authorized official:** THOMAS C TEATHER MD (MEDICAL DOCTOR)
- **Authorized official phone:** (321) 242-2026

## Contact information

- **Practice address:** 1478 HIGHLAND AVE, SUITE A, MELBOURNE, FL 32935-6561
- **Practice address phone:** (321) 242-2026
- **Practice address fax:** (321) 242-2423
- **Mailing address:** 1478 HIGHLAND AVE, SUITE A, MELBOURNE, FL 32935-6561
- **Mailing address phone:** (321) 242-2026
- **Mailing address fax:** (321) 242-2423

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207W00000X | Ophthalmology Physician | ME66195 | FL | Yes |

## Other

- **Enumeration date:** 08/19/2005
- **Last updated:** 10/21/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 375920200 | — | FL |