4TH STREET LASER & SURGERY CENTER INC
NPI 1902964174
Clinic/Center - Ambulatory Surgical in Santa Rosa, CA

Q: What is 4th Street Laser & Surgery Center Inc's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Ambulatory Surgical, with taxonomy code 261QA1903X.

Active since December 04, 2006CLIA 05D1008140 · Waiver

1720 4TH ST, SANTA ROSA, CA 95404(707) 546-8100(707) 544-6438 Get Directions Write a Review

NPPES record last updated: January 17, 2013. Verified against the NPPES registry weekly; last sync: July 26, 2026.

On this page

About 4th Street Laser & Surgery Center Inc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

4TH STREET LASER & SURGERY CENTER INC (NPI 1902964174) is a healthcare organization registered as an ambulatory surgical in Santa Rosa, California and active in the NPI registry since December 2006. The organization holds a CLIA Waiver certificate valid through January 9, 2027 and lists Elayne Clark, Administrator, as its authorized official.

NPPES Registry Identity

NPI1902964174

Entity TypeOrganization

Primary Taxonomy261QA1903X

Legal Business Name4TH STREET LASER & SURGERY CENTER INC

Location Address1720 4TH STSanta Rosa, CA 95404-3602

Mailing Address1720 4th StSanta Rosa, CA 95404-3602 · (707) 546-8100 · Fax (707) 544-6438

Phone(707) 546-8100

Fax(707) 544-6438

Organization SubpartNo

Authorized OfficialElayne ClarkAdministrator · (707) 546-8100

Enumeration DateDecember 4, 2006

Last NPPES UpdateJanuary 17, 2013

✔ NPI 1902964174 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Ambulatory SurgicalAmbulatory Health Care Facilities

Taxonomy Code261QA1903X

License✔ Licensed in CA · 110000344

1720 4TH ST, Santa Rosa, CA 95404

Open in Google Maps ↗

Other Identifiers 3

Other110000344CA · State Of Ca License

MedicaidSUR01428GCA

Medicare ID-Type UnspecifiedZZZ15550ZCA · Medicare Provider Id#

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 05D1008140

4th Street Laser & Surgery Center · Santa Rosa, CA

Active · expires Jan 9, 2027

CLIA Number05D1008140

Laboratory TypeAmbulatory Surgery Center

Certificate Effective DateJanuary 10, 2025

Certificate Expiration DateJanuary 9, 2027

Laboratory DirectorDr. Nina Ni

Laboratory Phone(707) 708-2808

Laboratory Location4th Street Laser & Surgery Center1720 Fourth Street, Santa Rosa, CA 95404

CLIA data matches this NPI record on: Name

This certificate is issued to a laboratory to perform only waived tests.

Areas of Expertise CMS Part B claims 7

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Removal of cataract with insertion of prosthetic lens 66984

This is a procedure where a cloudy lens in your eye, known as a cataract, is removed. After removal, a clear artificial lens is inserted. This helps to restore your vision, enabling you to see clearly again.

1,250 services773 patients

Phenylephrine 10.16 mg/ml and ketorolac 2.88 mg/ml ophthalmic irrigation solution, 1 ml J1097

This solution is used during eye surgery to maintain pupil dilation and reduce inflammation. Phenylephrine widens the pupil, while Ketorolac helps to prevent pain and swelling. It's applied directly to the eye by your healthcare provider during the procedure.

541 services102 patients

Removal of recurring cataract in lens capsule using a laser 66821

This procedure, known as YAG laser capsulotomy, treats cloudiness in the lens capsule following cataract surgery. A laser is used to create a small hole in the cloudy capsule, allowing light to pass through and restore clear vision. It's a quick, painless procedure.

500 services349 patients

Complex removal of cataract with insertion of prosthetic lens 66982

This procedure involves removing a cloudy lens (cataract) from your eye and replacing it with a clear, artificial lens. It helps restore vision that has been affected by the cataract. The operation is usually done under local anesthesia.

96 services75 patients

Extracapsular removal of cataract with insertion of artificial lens and insertion of drainage device in front chamber of eye 66991

This is a two-part eye procedure. First, a cloudy lens (cataract) is removed from its outer layer and replaced with an artificial lens to improve vision. Second, a drainage device is inserted into the front part of the eye to manage fluid levels, preventing pressure build-up.

62 services42 patients

Incision to improve eye fluid flow 65820

This procedure, known as a trabeculectomy, involves creating a small opening in the eye to improve fluid flow. This can help lower eye pressure in conditions like glaucoma. It's a common, safe procedure to protect your eye health.

29 services25 patients

Leave this field empty

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

NOVAMED SURGERY CENTER OF SANTA ROSA, LLC

Clinic/Center (Ambulatory Surgical)

1720 4TH ST
SANTA ROSA, CA 95404

Sonoma County (707) 546-8100

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is 4th Street Laser & Surgery Center Inc's NPI number?

The NPI number for 4th Street Laser & Surgery Center Inc is 1902964174. It was assigned to this organization in the NPPES registry on December 4, 2006.

Where is 4th Street Laser & Surgery Center Inc located?

4th Street Laser & Surgery Center Inc is located at 1720 4th St, Santa Rosa, CA 95404. The listed phone number is (707) 546-8100.

What is 4th Street Laser & Surgery Center Inc's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Ambulatory Surgical, with taxonomy code 261QA1903X.

Does 4th Street Laser & Surgery Center Inc hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 05D1008140) is associated with this NPI, valid through January 9, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for 4th Street Laser & Surgery Center Inc was last updated on January 17, 2013. NPI Profile syncs with the weekly NPPES data releases published by CMS.