Provider Demographics
NPI:1588751713
Name:LASER EYE SURGERY OF ERIE, INC
Entity type:Organization
Organization Name:LASER EYE SURGERY OF ERIE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:FREDERICK
Authorized Official - Last Name:HAVERLY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:814-455-7591
Mailing Address - Street 1:311 W 24TH ST
Mailing Address - Street 2:SUITE 401
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16502-2666
Mailing Address - Country:US
Mailing Address - Phone:814-455-7591
Mailing Address - Fax:814-452-6911
Practice Address - Street 1:311 W 24TH ST
Practice Address - Street 2:SUITE 401
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16502-2666
Practice Address - Country:US
Practice Address - Phone:814-455-7591
Practice Address - Fax:814-452-6911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-09
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYAA1204Medicare PIN
PA818196Medicare PIN
PAT72499Medicare UPIN
NYW95003Medicare UPIN
OH9318421Medicare PIN
PA0739350001Medicare NSC