Organization
WOODLANDS LASER CENTER LLP
Active
Other names
Berkeley Laser Center The Woodlands
Organization subpart
No
Provider details
NPI number
Authorized official
MARK F MICHELETTI (EXECUTIVE DIRECTOR)
(281) 348-4615
Entity
Organization
Contact information
Practice address
17450 ST LUKES WAY, SUITE 100, THE WOODLANDS, TX 77384-8045
(281) 363-3443
(936) 271-1361
Mailing address
17450 ST LUKES WAY, SUITE 100, THE WOODLANDS, TX 77384-8045
(281) 363-3443
(936) 271-1361
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
—
—
207W00000X
Ophthalmology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0050MS
BLUE CROSS BLUE SHIELD
TX
Enumeration date
07/25/2006
Last updated
09/18/2012
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