Laservue Eye Center a Medical Corporation

Primary specialty

Non-Pharmacy Dispensing SiteTaxonomy code 332900000X

License

G66178 Issued in CA

Legal business name

LASERVUE EYE CENTER A MEDICAL CORPORATION

Practice address

3450 Mendocino Ave
200
Santa Rosa, CA 95403-2221

Phone

(707) 522-6200

Fax

(707) 522-6215

NPI assigned

Jul 23, 2015

Last updated

Jul 23, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Nicole Sisko

Title

Credentialing Specialist

Phone

(727) 483-7463

Specialties & licenses 1

Addresses

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 Medical Corporation

  • Ophthalmologic Surgery Clinic/Center
  • Santa Rosa, CA
  • NPI 1194913103
  NPD tax ID

Locations

Practitioners 1

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.

• Sanjay Bansal, M.D.

  • Ophthalmology Physician
  • Santa Rosa, CA
  • NPI 1346275484
  NPD (past)

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

{
    "created_epoch": "1437609600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1437609600000",
    "number": "1811372568",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "311 PARK PLACE BLVD",
            "address_2": "5TH FLOOR",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "337594904",
            "telephone_number": "727-483-7463",
            "fax_number": "727-755-0679"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3450 MENDOCINO AVE",
            "address_2": "200",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954032221",
            "telephone_number": "707-522-6200",
            "fax_number": "707-522-6215"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LASERVUE EYE CENTER A MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-23",
        "last_updated": "2015-07-23",
        "status": "A",
        "authorized_official_last_name": "SISKO",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "727-483-7463"
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": "CA",
            "license": "G66178",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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

• Non-Pharmacy Dispensing Site in Santa Rosa, CA
• Providers in Santa Rosa, CA by specialty
• Non-Pharmacy Dispensing Site in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.