Provider Demographics
NPI:1710186994
Name:LASE MED, INC.
Entity type:Organization
Organization Name:LASE MED, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTONELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARPENTER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:702-953-0267
Mailing Address - Street 1:1894 US HIGHWAY 50 E
Mailing Address - Street 2:STE 4 #160
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89701-3244
Mailing Address - Country:US
Mailing Address - Phone:702-953-0267
Mailing Address - Fax:702-967-0211
Practice Address - Street 1:500 N POPLAR AVE
Practice Address - Street 2:STE A
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-2337
Practice Address - Country:US
Practice Address - Phone:918-398-9577
Practice Address - Fax:918-398-4488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-17
Last Update Date:2009-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3803305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service