MEDICARE: DR. MARILU O'BYRNE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	016256	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083772453
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARILU O'BYRNE M.D.

Provider Business Mailing Address
First Line	:	1580 W CAUSEWAY APPROACH
Second Line	:	SUITE 3
City	:	MANDEVILLE
State	:	LA
Zip	:	70471-3033
Country	:	US
Telephone Number	:	985-624-5573
Fax Number	:	985-624-9106

Provider Business Practice Location Address
First Line	:	1580 W CAUSEWAY APPROACH
Second Line	:	SUITE 3
City	:	MANDEVILLE
State	:	LA
Zip	:	70471-3033
Country	:	US
Telephone Number	:	985-624-5573
Fax Number	:	985-624-9106

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/05/2006
Last Update Date	:	05/29/2008

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