Provider Demographics
NPI:1811085491
Name:VISION SURGERY & LASER CENTER A SURGICAL MEDICAL GROUP INC
Entity type:Organization
Organization Name:VISION SURGERY & LASER CENTER A SURGICAL MEDICAL GROUP INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-455-6800
Mailing Address - Street 1:8910 UNIVERSITY CENTER LN
Mailing Address - Street 2:SUITE 800
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-1031
Mailing Address - Country:US
Mailing Address - Phone:858-455-6800
Mailing Address - Fax:858-455-0244
Practice Address - Street 1:8910 UNIVERSITY CENTER LN
Practice Address - Street 2:SUITE 800
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92122-1031
Practice Address - Country:US
Practice Address - Phone:858-455-6800
Practice Address - Fax:858-455-0244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW15371Medicare UPIN
CA4147030001Medicare NSC