Provider Demographics
NPI:1366563405
Name:LOUISIANA EYE CENTER, APMC
Entity type:Organization
Organization Name:LOUISIANA EYE CENTER, APMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSCIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:RICELLE
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:225-356-2655
Mailing Address - Street 1:7855 HOWELL BLVD
Mailing Address - Street 2:SUITE 130A
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70807
Mailing Address - Country:US
Mailing Address - Phone:225-356-2655
Mailing Address - Fax:225-356-2358
Practice Address - Street 1:7855 HOWELL BLVD
Practice Address - Street 2:SUITE 130A
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70807
Practice Address - Country:US
Practice Address - Phone:225-356-2655
Practice Address - Fax:225-356-2358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA020628261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1112160Medicaid
LAF46969Medicare UPIN
LA4EO22Medicare ID - Type Unspecified
LA1112160Medicaid