Provider Demographics
NPI:1114959608
Name:EYE SPECIALISTS OF LOUISIANA, LLC
Entity type:Organization
Organization Name:EYE SPECIALISTS OF LOUISIANA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSIE
Authorized Official - Middle Name:B
Authorized Official - Last Name:BUCKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-768-7777
Mailing Address - Street 1:6220 PERKINS ROAD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-4120
Mailing Address - Country:US
Mailing Address - Phone:225-768-7777
Mailing Address - Fax:225-214-3400
Practice Address - Street 1:6220 PERKINS ROAD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4120
Practice Address - Country:US
Practice Address - Phone:225-768-7777
Practice Address - Fax:225-214-3400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2019-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5C951Medicare ID - Type UnspecifiedGROUP NUMBER