Organization
LASERVUE EYE CENTER A MEDICAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICOLE SISKO (CREDENTIALING SPECIALIST)
(727) 483-7463
Entity
Organization
Contact information
Practice address
3450 MENDOCINO AVE, 200, SANTA ROSA, CA 95403-2221
(707) 522-6200
(707) 522-6215
Mailing address
311 PARK PLACE BLVD, 5TH FLOOR, CLEARWATER, FL 33759-4904
(727) 483-7463
(727) 755-0679
Taxonomy
Speciality
Code
Description
License number
State
332900000X
Non-Pharmacy Dispensing Site
Primary
G66178
CA
Other
Enumeration date
07/23/2015
Last updated
07/23/2015
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