Healthcare Provider Details

I. General information

NPI: 1831114073
Provider Name (Legal Business Name): DAVID MICHAEL OSTRICK O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 03/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1518 W AIRLINE HWY
LA PLACE LA
70068-3725
US

IV. Provider business mailing address

529 BROCKENBRAUGH CT
METAIRIE LA
70005-2709
US

V. Phone/Fax

Practice location:
  • Phone: 985-652-4097
  • Fax: 985-652-4097
Mailing address:
  • Phone: 504-831-2253
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number850-103T
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: