Provider Demographics
NPI:1629806369
Name:CENTOLA, LAURA MELISSA (OD)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:MELISSA
Last Name:CENTOLA
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 1:351 30TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70124-1333
Mailing Address - Country:US
Mailing Address - Phone:318-789-5153
Mailing Address - Fax:
Practice Address - Street 1:4324 VETERANS MEMORIAL BLVD STE 102
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-5429
Practice Address - Country:US
Practice Address - Phone:504-455-9825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-24
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2025-971AT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist