Provider Demographics
NPI:1093009557
Name:LASER EYE CARE OF CALIFORNIA
Entity type:Organization
Organization Name:LASER EYE CARE OF CALIFORNIA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DOUG
Authorized Official - Middle Name:
Authorized Official - Last Name:SMALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-854-7400
Mailing Address - Street 1:3501 JAMBOREE RD
Mailing Address - Street 2:SUITE #200
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-2939
Mailing Address - Country:US
Mailing Address - Phone:949-854-7400
Mailing Address - Fax:949-509-4898
Practice Address - Street 1:23550 HAWTHORNE BLVD
Practice Address - Street 2:SUITE #220
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-4731
Practice Address - Country:US
Practice Address - Phone:310-784-2020
Practice Address - Fax:310-784-2021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-01
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery