Melbourne United Laser Vision Association LLC

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

ME66195 Issued in FL

Legal business name

MELBOURNE UNITED LASER VISION ASSOCIATION LLC

Practice address

1478 Highland Ave
Suite a
Melbourne, FL 32935-6561

Phone

(321) 242-2026

Fax

(321) 242-2423

NPI assigned

Aug 19, 2005

Organization subpart

No

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

Authorized official

Name

Thomas C Teather, MD

Title

Medical Doctor

Phone

(321) 242-2026

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1124409600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1382313600000",
    "number": "1891787446",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1478 HIGHLAND AVE",
            "address_2": "SUITE A",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329356561",
            "telephone_number": "321-242-2026",
            "fax_number": "321-242-2423"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1478 HIGHLAND AVE",
            "address_2": "SUITE A",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329356561",
            "telephone_number": "321-242-2026",
            "fax_number": "321-242-2423"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MELBOURNE UNITED LASER VISION ASSOCIATION LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-19",
        "last_updated": "2013-10-21",
        "status": "A",
        "authorized_official_last_name": "TEATHER",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "MEDICAL DOCTOR",
        "authorized_official_telephone_number": "321-242-2026",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": "FL",
            "license": "ME66195",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "375920200",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Ophthalmology Physician in Melbourne, FL
• Providers in Melbourne, FL by specialty
• Ophthalmology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2013; 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.