Provider Demographics
NPI:1396991105
Name:ERNEST A WILBUR
Entity type:Organization
Organization Name:ERNEST A WILBUR
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERNEST
Authorized Official - Middle Name:A
Authorized Official - Last Name:WILBUR
Authorized Official - Suffix:III
Authorized Official - Credentials:OD
Authorized Official - Phone:504-368-5320
Mailing Address - Street 1:701 POYDRAS ST
Mailing Address - Street 2:SUITE 117
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70139-6001
Mailing Address - Country:US
Mailing Address - Phone:504-368-5320
Mailing Address - Fax:
Practice Address - Street 1:701 POYDRAS ST
Practice Address - Street 2:SUITE 117
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70139-6001
Practice Address - Country:US
Practice Address - Phone:504-368-5320
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-12
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1397806Medicaid