Organization
MELBOURNE UNITED LASER VISION ASSOCIATION LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS C TEATHER MD (MEDICAL DOCTOR)
(321) 242-2026
Entity
Organization
Contact information
Practice address
1478 HIGHLAND AVE, SUITE A, MELBOURNE, FL 32935-6561
(321) 242-2026
(321) 242-2423
Mailing address
1478 HIGHLAND AVE, SUITE A, MELBOURNE, FL 32935-6561
(321) 242-2026
(321) 242-2423
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
ME66195
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
375920200
—
FL
Enumeration date
08/19/2005
Last updated
10/21/2013
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