Provider Demographics
NPI:1336272921
Name:DAKOTA LASER VISION, PLLC
Entity type:Organization
Organization Name:DAKOTA LASER VISION, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:BAITCH
Authorized Official - Suffix:
Authorized Official - Credentials:OD, PHD
Authorized Official - Phone:734-926-0196
Mailing Address - Street 1:1785 W STADIUM BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-5257
Mailing Address - Country:US
Mailing Address - Phone:734-926-0196
Mailing Address - Fax:734-926-0195
Practice Address - Street 1:1785 W STADIUM BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-5257
Practice Address - Country:US
Practice Address - Phone:734-926-0196
Practice Address - Fax:734-926-0195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty