Provider Demographics
NPI:1992709885
Name:THE RETINAL INSTITUTE OF LOUISIANA
Entity type:Organization
Organization Name:THE RETINAL INSTITUTE OF LOUISIANA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:NEWSOME
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:504-246-1966
Mailing Address - Street 1:10001 LAKE FOREST BLVD
Mailing Address - Street 2:STE 701
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70127-5264
Mailing Address - Country:US
Mailing Address - Phone:504-246-1966
Mailing Address - Fax:504-241-0743
Practice Address - Street 1:10001 LAKE FOREST BLVD
Practice Address - Street 2:STE 701
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70127-5264
Practice Address - Country:US
Practice Address - Phone:504-246-1966
Practice Address - Fax:504-241-0743
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA072372207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1355275Medicaid
LA1550710Medicaid
LA1941174Medicaid
LA1355275Medicaid
LA50639Medicare ID - Type UnspecifiedDR.NEWSOME INDIV. MCAR #
LA1550710Medicaid