Provider Demographics
NPI:1699886325
Name:STEVENSON MEDICAL SURGICAL EYE CENTER
Entity type:Organization
Organization Name:STEVENSON MEDICAL SURGICAL EYE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ONEX
Authorized Official - Middle Name:DARA
Authorized Official - Last Name:STEVENSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:985-537-7000
Mailing Address - Street 1:4777 HWY 1 SOUTH
Mailing Address - Street 2:
Mailing Address - City:RACELAND
Mailing Address - State:LA
Mailing Address - Zip Code:70394
Mailing Address - Country:US
Mailing Address - Phone:985-537-7000
Mailing Address - Fax:985-537-7001
Practice Address - Street 1:4777 HWY 1 S
Practice Address - Street 2:
Practice Address - City:RACELAND
Practice Address - State:LA
Practice Address - Zip Code:70394
Practice Address - Country:US
Practice Address - Phone:985-537-7000
Practice Address - Fax:985-537-7001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA02476R207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1798894Medicaid
LA57109Medicare UPIN
57109Medicare ID - Type Unspecified
LA1798894Medicaid