Organization
LASERVUE EYE CENTER MEDICAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SANJAY BANSAL M.D. (OWNER)
(707) 522-6200
Entity
Organization
Contact information
Practice address
3540 MENDOCINO AVE STE 200, SANTA ROSA, CA 95403-3639
(707) 522-6200
Mailing address
3540 MENDOCINO AVE STE 200, SANTA ROSA, CA 95403-3639
(707) 522-6200
Taxonomy
Speciality
Code
Description
License number
State
261QS0132X
Ophthalmologic Surgery Clinic/Center
Primary
G66178
CA
Other
Enumeration date
10/04/2007
Last updated
04/03/2013
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