NPIMap

Organization Active NPI

Eye Surgery and Laser Clinic, Inc.

  • Ambulatory Surgical Clinic/Center
  • Concord, NC
National Provider Identifier
1093779951
Registry record updated Jun 9, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
License
87485 Issued in NC
Legal business name
EYE SURGERY AND LASER CLINIC, INC.
Practice address
500 Lake Concord Rd
Concord, NC 28025-2926
Phone
(704) 782-1127
Fax
(704) 782-1207
NPI assigned
Apr 17, 2006
Last updated
Jun 9, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 9, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. David K. Harper, M. D.NPI 1134129513
Title
President
Phone
(704) 782-1127

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X 87485 NC Primary

Addresses

Primary practice location

500 Lake Concord Rd
Concord, NC 28025-2926

Mailing address

500 Lake Concord Rd NE
Concord, NC 28025-2926
Phone (704) 782-1127

Other identifiers 3

IdentifierTypeStateIssuer
805608OtherNCPARTNERS MEDICARE
00618OtherNCBLUE CROSS BLUE SHIELD
3409839MedicaidNC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080424000164 NC Part B Supplier - Ambulatory Surgical Center 8820176316 Receives reassigned benefits from 2 practitioners
Practice locations: Concord, NC

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Eye Surgery and Laser ClinicCCN 34C0001010
Medicare certification status
ActiveFrom the Provider of Services file

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
34D2091337Eye Surgery and Laser Clinic, Inc500 Lake Concord Road NE, Concord, NC 28025Certificate of waiverFeb 10, 2027

National Provider Directory

National Provider Directory

Locations

500 Lake Concord Rd NE
Concord, NC 28025
Phone (704) 782-1127

Practitioners & affiliated clinicians

Practitioners 17

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 17

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1145232000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1212969600000",
    "number": "1093779951",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 LAKE CONCORD RD NE",
            "city": "CONCORD",
            "state": "NC",
            "postal_code": "280252926",
            "telephone_number": "704-782-1127",
            "fax_number": "704-782-1207"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 LAKE CONCORD RD",
            "city": "CONCORD",
            "state": "NC",
            "postal_code": "280252926",
            "telephone_number": "704-782-1127",
            "fax_number": "704-782-1207"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EYE SURGERY AND LASER CLINIC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-17",
        "last_updated": "2008-06-09",
        "status": "A",
        "authorized_official_last_name": "HARPER",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "K.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "704-782-1127",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M. D."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "NC",
            "license": "87485",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PARTNERS MEDICARE",
            "identifier": "805608",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "00618",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3409839",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Concord, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.