Healthcare Provider Details

I. General information

NPI: 1619288198
Provider Name (Legal Business Name): PATRICK R MAGEE OD APOC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2010
Last Update Date: 09/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4510 AMBASSADOR CAFFERY PKWY SUITE A
LAFAYETTE LA
70508-6931
US

IV. Provider business mailing address

4510 AMBASSADOR CAFFERY PKWY SUITE A
LAFAYETTE LA
70508-6931
US

V. Phone/Fax

Practice location:
  • Phone: 337-984-2020
  • Fax: 713-995-0548
Mailing address:
  • Phone: 337-984-2020
  • Fax: 713-995-0548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number916-070T
License Number StateLA

VIII. Authorized Official

Name: PATRICK R MAGEE
Title or Position: DOCTOR OF OPTOMETRY
Credential: O.D.
Phone: 337-984-2020