Provider Demographics
NPI:1194140475
Name:DR. MANUEL M. DE LA RUA, O.D., L.L.C.
Entity type:Organization
Organization Name:DR. MANUEL M. DE LA RUA, O.D., L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:TRACEY
Authorized Official - Last Name:DE LA RUA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-443-9485
Mailing Address - Street 1:3701 WILLIAMS BLVD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70065-3070
Mailing Address - Country:US
Mailing Address - Phone:504-443-9485
Mailing Address - Fax:504-443-5834
Practice Address - Street 1:3701 WILLIAMS BLVD
Practice Address - Street 2:SUITE 204
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70065-3070
Practice Address - Country:US
Practice Address - Phone:504-443-9485
Practice Address - Fax:504-443-5834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-24
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA992-202T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty