1124071717 NPI number — EYE ASSOCIATES LLC

Table of content: (NPI 1124071717)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124071717 NPI number — EYE ASSOCIATES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EYE ASSOCIATES LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
EYE SURGERY CENTER OF LOUISIANA
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124071717
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/01/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3530 HOUMA BLVD
Provider Second Line Business Mailing Address:
STE 203
Provider Business Mailing Address City Name:
METAIRIE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70006-4202
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-887-7660
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3530 HOUMA BLVD
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
METAIRIE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-887-7660
Provider Business Practice Location Address Fax Number:
504-887-7816
Provider Enumeration Date:
05/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WILLIS
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
DAVID
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
504-455-1816

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1441121 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1104014216 . This is a "NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 03258518 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




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