Provider Demographics
NPI:1215995527
Name:IBERIA EYE CENTER,LLC
Entity type:Organization
Organization Name:IBERIA EYE CENTER,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:DOUGLASS
Authorized Official - Last Name:HALL
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:337-256-8395
Mailing Address - Street 1:1110 ANGERS ST
Mailing Address - Street 2:
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70563-2012
Mailing Address - Country:US
Mailing Address - Phone:337-256-8395
Mailing Address - Fax:337-256-8396
Practice Address - Street 1:1110 ANGERS ST
Practice Address - Street 2:
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70563-2012
Practice Address - Country:US
Practice Address - Phone:337-256-8395
Practice Address - Fax:337-256-8396
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5CT57Medicare PIN