Healthcare Provider Details

I. General information

NPI: 1396724639
Provider Name (Legal Business Name): EUGENE GARY OPPMAN O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2006
Last Update Date: 09/28/2023
Certification Date: 09/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 MARTIN LUTHER KING JR ST
INDEPENDENCE LA
70443-2387
US

IV. Provider business mailing address

PO BOX 10190
NEW ORLEANS LA
70181-0190
US

V. Phone/Fax

Practice location:
  • Phone: 985-878-1066
  • Fax: 504-617-6303
Mailing address:
  • Phone: 985-878-1066
  • Fax: 504-617-6303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1033-109T
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: