Healthcare Provider Details

I. General information

NPI: 1043470594
Provider Name (Legal Business Name): HOTH EYE CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2008
Last Update Date: 06/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7777 HENNESSY BLVD SUITE 5000
BATON ROUGE LA
70808-4300
US

IV. Provider business mailing address

7777 HENNESSY BLVD SUITE 5000
BATON ROUGE LA
70808-4300
US

V. Phone/Fax

Practice location:
  • Phone: 225-768-7777
  • Fax: 225-214-3400
Mailing address:
  • Phone: 225-768-7777
  • Fax: 225-214-3400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number010934
License Number StateLA

VIII. Authorized Official

Name: REBA A PLAISANCE
Title or Position: OFFICE MANAGER
Credential:
Phone: 225-768-7777