Provider Demographics
NPI:1962229369
Name:POLAND EYE AND LASER CENTER, LLC
Entity type:Organization
Organization Name:POLAND EYE AND LASER CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:FLEBOTTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-394-8579
Mailing Address - Street 1:14 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:POLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44514-1914
Mailing Address - Country:US
Mailing Address - Phone:330-757-1519
Mailing Address - Fax:330-757-1510
Practice Address - Street 1:14 S MAIN ST
Practice Address - Street 2:
Practice Address - City:POLAND
Practice Address - State:OH
Practice Address - Zip Code:44514-1914
Practice Address - Country:US
Practice Address - Phone:330-757-1519
Practice Address - Fax:330-757-1510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-25
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty