1992709885 NPI number — THE RETINAL INSTITUTE OF LOUISIANA

Table of content: (NPI 1992709885)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992709885 NPI number — THE RETINAL INSTITUTE OF LOUISIANA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE RETINAL INSTITUTE OF LOUISIANA
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:
Provider Other Organization Name Type Code:
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:
1992709885
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10001 LAKE FOREST BLVD
Provider Second Line Business Mailing Address:
STE 701
Provider Business Mailing Address City Name:
NEW ORLEANS
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70127-5264
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-246-1966
Provider Business Mailing Address Fax Number:
504-241-0743

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10001 LAKE FOREST BLVD
Provider Second Line Business Practice Location Address:
STE 701
Provider Business Practice Location Address City Name:
NEW ORLEANS
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70127-5264
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-246-1966
Provider Business Practice Location Address Fax Number:
504-241-0743
Provider Enumeration Date:
06/08/2005

Additional Information

Authorized Official

Authorized Official Last Name:
NEWSOME
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
ANTHONY
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
504-246-1966

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  072372 , 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: 1355275 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1550710 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1941174 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com