Lasik Provision, PC

Primary specialty

Corneal and Contact Management OptometristTaxonomy code 152WC0802X

License

TUV005851-1 Issued in NY

Legal business name

LASIK PROVISION, PC

Practice address

5792 Widewaters Pkwy
De Witt, NY 13214-1847

Phone

(315) 295-3937

NPI assigned

Nov 1, 2007

Last updated

Nov 1, 2007By 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

Mr. Jesse Andrew Reap

Title

Clinic Director

Phone

(315) 295-3937

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1193875200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1193875200000",
    "number": "1821277294",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5792 WIDEWATERS PKWY",
            "city": "DE WITT",
            "state": "NY",
            "postal_code": "132141847",
            "telephone_number": "315-295-3937"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5792 WIDEWATERS PKWY",
            "city": "DE WITT",
            "state": "NY",
            "postal_code": "132141847",
            "telephone_number": "315-295-3937"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LASIK PROVISION, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-01",
        "last_updated": "2007-11-01",
        "status": "A",
        "authorized_official_last_name": "REAP",
        "authorized_official_first_name": "JESSE",
        "authorized_official_middle_name": "ANDREW",
        "authorized_official_title_or_position": "CLINIC DIRECTOR",
        "authorized_official_telephone_number": "315-295-3937",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "152WC0802X",
            "taxonomy_group": "",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "NY",
            "license": "TUV005851-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Theresa Ann Jenkins
• Kimberly Kalil
• Catherine Ann Keough, PT, DPT
• Donald Joseph Ladd, PHARMD
• Norman A Lasda, M.D.
• Tanya O Lemon, LPN
• June Leo-Randazzo, O.T.
• Luxottica Retail North America Inc (Pearle Vision #C6443)
• Gavin John Maclachlan, EMT
• Mary Mandelis

• Corneal and Contact Management Optometrist in De Witt, NY
• Providers in De Witt, NY by specialty
• Corneal and Contact Management Optometrist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2007; 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.