1356344790 NPI number — JOSEPH & SWAN EYE CENTER, A PROFESSIONAL MEDICAL CORPORATION

Table of content: (NPI 1356344790)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356344790 NPI number — JOSEPH & SWAN EYE CENTER, A PROFESSIONAL MEDICAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOSEPH & SWAN EYE CENTER, A PROFESSIONAL MEDICAL CORPORATION
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:
JOSEPH & SWAN EYE CENTER
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:
1356344790
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/19/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
214 SOUTHCITY PKWY STE 101
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAFAYETTE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70503-5718
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-981-6430
Provider Business Mailing Address Fax Number:
337-981-9134

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
214 SOUTHCITY PKWY STE 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAFAYETTE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70503-5718
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-981-6430
Provider Business Practice Location Address Fax Number:
337-981-9134
Provider Enumeration Date:
05/31/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BROUSSARD
Authorized Official First Name:
JULIE
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
337-981-6430

Provider Taxonomy Codes

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

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

  • Identifier: 1356344790 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 1356344790 . This is a "AMERICAN LIFECARE" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 1356344790 . This is a "BESTCARE" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 1356344790 . This is a "PHCS" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 1356344790 . This is a "VERITY" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 1356344790 . This is a "COVENTRY" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 1356344790 . This is a "ST. EMPLOYEES GROUP" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 1356344790 . This is a "MULTI PLAN" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 1356344790 . This is a "GILSBAR 360" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 1356344790 . This is a "BLUE CROSS & BLUE SHIELD OF LOUISIANA" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 1356344790 . This is a "PPO PLUS" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




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