Provider Demographics
NPI:1962520973
Name:LASKERR, GREGORY MARK (OD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:MARK
Last Name:LASKERR
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:2232 UNIVERSITY SQUARE MALL
Mailing Address - Street 2:SUITE 362
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-5518
Mailing Address - Country:US
Mailing Address - Phone:813-977-6111
Mailing Address - Fax:813-979-9809
Practice Address - Street 1:2232 UNIVERSITY SQUARE MALL
Practice Address - Street 2:SUITE 362
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-5518
Practice Address - Country:US
Practice Address - Phone:813-977-6111
Practice Address - Fax:813-979-9809
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOPC2910152WC0802X, 152WP0200X, 152WS0006X, 152WX0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Not Answered152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Not Answered152WS0006XEye and Vision Services ProvidersOptometristSports Vision
Not Answered152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLV06621Medicare UPIN