Provider Demographics
NPI:1174927602
Name:LAGUNA HILLS REFRACTIVE LLC
Entity type:Organization
Organization Name:LAGUNA HILLS REFRACTIVE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL COUNSEL
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHARICE
Authorized Official - Middle Name:Y
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-534-2234
Mailing Address - Street 1:16305 SWINGLEY RIDGE RD
Mailing Address - Street 2:300
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-1777
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:24401 CALLE DE LA LOUISA
Practice Address - Street 2:STE 300
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-3623
Practice Address - Country:US
Practice Address - Phone:636-534-2300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TLC VISION CENTERS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-10-13
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center