Provider Demographics
NPI:1306260013
Name:GOTHAM LASIK VISION
Entity type:Organization
Organization Name:GOTHAM LASIK VISION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BONANNI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-581-1280
Mailing Address - Street 1:346 W 57TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-3702
Mailing Address - Country:US
Mailing Address - Phone:212-581-1280
Mailing Address - Fax:212-616-9998
Practice Address - Street 1:346 W 57TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-3702
Practice Address - Country:US
Practice Address - Phone:212-581-1280
Practice Address - Fax:212-616-9998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-17
Last Update Date:2014-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY211558207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty