Provider Demographics
NPI:1215096490
Name:EYECARE AND SURGICAL ASSOCIATES
Entity type:Organization
Organization Name:EYECARE AND SURGICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RECEPTIONIST
Authorized Official - Prefix:MISS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:A
Authorized Official - Last Name:GREENHOUSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-253-9766
Mailing Address - Street 1:108 MEDIC AVE
Mailing Address - Street 2:
Mailing Address - City:MARKSVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71351-3099
Mailing Address - Country:US
Mailing Address - Phone:318-253-9766
Mailing Address - Fax:318-253-8094
Practice Address - Street 1:108 MEDIC AVE
Practice Address - Street 2:
Practice Address - City:MARKSVILLE
Practice Address - State:LA
Practice Address - Zip Code:71351-3099
Practice Address - Country:US
Practice Address - Phone:318-253-9766
Practice Address - Fax:318-253-8094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1948691Medicaid
LA180034882OtherRAILROAD MEDICARE
LA185374602OtherUNITED HEALTH
LA=========0OtherBLUE CROSS AND BLUE SHIEL
LA1948691Medicaid
LA4616000001Medicare NSC