Provider Demographics
NPI:1528274719
Name:LASER AND VISION SURGERY CENTER, LLC
Entity type:Organization
Organization Name:LASER AND VISION SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTALDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-643-3900
Mailing Address - Street 1:178 HARTFORD RD
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-5986
Mailing Address - Country:US
Mailing Address - Phone:860-649-9973
Mailing Address - Fax:
Practice Address - Street 1:178 HARTFORD RD
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-5986
Practice Address - Country:US
Practice Address - Phone:860-649-9973
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0163261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT17402OtherSPECTRA
CT352OtherANTHEM
CT117819OtherEYEMED
CT004207032OtherMEDICAID
CT774128OtherCONNECTICARE
CTA2021364OtherOXFORD
CT2380780OtherAETNA
CT490004322OtherRAILROAD MEDICARE
CTIV7858OtherHEALTH NET
CT20472OtherCOLE MANAGED
CT490000215Medicare PIN