Provider Demographics
NPI:1154553071
Name:TAYLOR, NOEL SCOTT (OD)
Entity type:Individual
Prefix:
First Name:NOEL
Middle Name:SCOTT
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 POLK ST
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:LA
Mailing Address - Zip Code:71052-2421
Mailing Address - Country:US
Mailing Address - Phone:318-423-9807
Mailing Address - Fax:318-872-0748
Practice Address - Street 1:2434 HIGHWAY 171
Practice Address - Street 2:
Practice Address - City:STONEWALL
Practice Address - State:LA
Practice Address - Zip Code:71078-9420
Practice Address - Country:US
Practice Address - Phone:318-925-2345
Practice Address - Fax:318-925-3456
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-11
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1575-608T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1889024Medicaid
AR180171722Medicaid
LA1889024Medicaid
LA4M2366742Medicare PIN