Provider Demographics
NPI:1952570962
Name:GLOBAL LASER VISION MEDICAL CENTER
Entity type:Organization
Organization Name:GLOBAL LASER VISION MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:FARZAD
Authorized Official - Middle Name:
Authorized Official - Last Name:YAGHOUTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-243-2444
Mailing Address - Street 1:6950 FRIARS RD STE 100
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-5107
Mailing Address - Country:US
Mailing Address - Phone:619-243-2444
Mailing Address - Fax:619-243-2443
Practice Address - Street 1:6950 FRIARS RD STE 100
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-5107
Practice Address - Country:US
Practice Address - Phone:619-243-2444
Practice Address - Fax:619-243-2443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-23
Last Update Date:2008-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG085172152W00000X, 152WC0802X, 156FC0800X, 156FC0801X, 156FX1100X, 156FX1101X, 156FX1201X, 156FX1202X, 156FX1800X, 207W00000X
CAG081572152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Multi-Specialty
No152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Multi-Specialty
No156FC0800XEye and Vision Services ProvidersTechnician/TechnologistContact LensGroup - Multi-Specialty
No156FC0801XEye and Vision Services ProvidersTechnician/TechnologistContact Lens FitterGroup - Multi-Specialty
No156FX1100XEye and Vision Services ProvidersTechnician/TechnologistOphthalmicGroup - Multi-Specialty
No156FX1101XEye and Vision Services ProvidersTechnician/TechnologistOphthalmic AssistantGroup - Multi-Specialty
No156FX1201XEye and Vision Services ProvidersTechnician/TechnologistOptometric AssistantGroup - Multi-Specialty
No156FX1202XEye and Vision Services ProvidersTechnician/TechnologistOptometric TechnicianGroup - Multi-Specialty
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty