Provider Demographics
NPI:1366400889
Name:LOUISIANA RETINA CONSULTANTS, LLC
Entity type:Organization
Organization Name:LOUISIANA RETINA CONSULTANTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:I
Authorized Official - Last Name:BLEM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-264-1011
Mailing Address - Street 1:134 HOSPITAL DR
Mailing Address - Street 2:STE. 100
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-2819
Mailing Address - Country:US
Mailing Address - Phone:337-264-1011
Mailing Address - Fax:337-264-1211
Practice Address - Street 1:134 HOSPITAL DR
Practice Address - Street 2:STE. 100
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2819
Practice Address - Country:US
Practice Address - Phone:337-264-1011
Practice Address - Fax:337-264-1211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5CU02Medicare ID - Type Unspecified