Laservue Eye Center Medical Corporation

Primary specialty

Ophthalmologic Surgery Clinic/CenterTaxonomy code 261QS0132X

License

G66178 Issued in CA

Legal business name

LASERVUE EYE CENTER MEDICAL CORPORATION

Practice address

3540 Mendocino Ave Ste 200
Santa Rosa, CA 95403-3639

Phone

(707) 522-6200

NPI assigned

Oct 4, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Sanjay Bansal, M.D.NPI 1346275484

Title

Owner

Phone

(707) 522-6200

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA2 enrollments

Enrollment records 2

Listed as

Laservue Eye Center Medical CorporationCCN 05C0001962

Medicare certification status

ActiveFrom the Provider of Services file

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

CLIA laboratory certificates

Tax ID family

Laservue Eye Center a Medical Corporation2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Laservue Eye Center a Medical Corporation

  • Non-Pharmacy Dispensing Site
  • Santa Rosa, CA
  • NPI 1811372568
  NPD tax ID

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Sanjay Bansal, M.D.

  • Ophthalmology Physician
  • Santa Rosa, CA
  • NPI 1346275484
  Medicare reassignment Care Compare group NPD Authorized official
• Stephanie Chiang Wangyu, MD

  • Student in an Organized Health Care Education/Training Program
  • Aurora, CO
  • NPI 1194306225

  CA

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1191456000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1364947200000",
    "number": "1194913103",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3540 MENDOCINO AVE STE 200",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954033639",
            "telephone_number": "707-522-6200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3540 MENDOCINO AVE STE 200",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954033639",
            "telephone_number": "707-522-6200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LASERVUE EYE CENTER MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-04",
        "last_updated": "2013-04-03",
        "status": "A",
        "authorized_official_last_name": "BANSAL",
        "authorized_official_first_name": "SANJAY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "707-522-6200",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QS0132X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ophthalmologic Surgery",
            "state": "CA",
            "license": "G66178",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer Larson, RPH
• Kathryn Dianne Larson, P.T.
• Nichole Larson
• Carl Larusson, DPM
• Laservue Eye Center a Medical Corporation
• Clarissa Lauren Lasky
• Marinar Fe Latada, OTR/L
• Nick Latchaw
• Gary M Latham, DDS
• Nancy Latimer, RN, NP

• Ophthalmologic Surgery Clinic/Center in Santa Rosa, CA
• Providers in Santa Rosa, CA by specialty
• Ophthalmologic Surgery Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2013; 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.