Provider Demographics
NPI:1366514424
Name:BORNE, MADELINE MAXINE (OD)
Entity type:Individual
Prefix:DR
First Name:MADELINE
Middle Name:MAXINE
Last Name:BORNE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4200 CANAL ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70119-5984
Mailing Address - Country:US
Mailing Address - Phone:504-451-8673
Mailing Address - Fax:
Practice Address - Street 1:4200 CANAL ST
Practice Address - Street 2:SUITE D
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-5984
Practice Address - Country:US
Practice Address - Phone:504-451-8673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2009-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1007-345T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1363863Medicaid
LA1363863Medicaid