MEDICARE: CAROLA B. OKOGBAA 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	MD.201426	LA

General Provider Information

NPI Number	:	1295919991
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLA B. OKOGBAA M.D.

Provider Business Mailing Address
First Line	:	7855 HOWELL BLVD
Second Line	:	SUITE 130A
City	:	BATON ROUGE
State	:	LA
Zip	:	70807-5256
Country	:	US
Telephone Number	:	225-356-2655
Fax Number	:	225-356-2358

Provider Business Practice Location Address
First Line	:	7855 HOWELL BLVD
Second Line	:	SUITE 130A
City	:	BATON ROUGE
State	:	LA
Zip	:	70807-5256
Country	:	US
Telephone Number	:	225-356-2655
Fax Number	:	225-356-2358

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

Provider Enumeration Date	:	12/18/2007
Last Update Date	:	05/14/2014

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